Treatment of onychomycosis: pros and cons of antifungal agents.
BACKGROUND
Antifungal agents are beneficial in the treatment of onychomycosis in the general population, as well as in children, the elderly, and immunocompromised individuals. Special patient populations can be more difficult to treat due to such factors as drug interactions with concomitant medications, adverse events, and poor compliance. In addition, there is limited information about the use of antifungal agents in special populations, e.g., children.


OBJECTIVE
The pros and cons of oral and topical antifungal agents are discussed, with focus on special patient populations.


METHODS
We searched MedLine (1966 to April 2003) for clinical studies evaluating the efficacy of oral and topical antifungal agents to treat onychomycosis. The key words used in conjunction with "onychomycosis" include: "terbinafine," "itraconazole," "fluconazole," "amorolfine nail lacquer," "ciclopirox nail lacquer," "HIV," "transplant patients," "diabetes," "children," and "elderly." Studies were excluded if published in a language other than English.


RESULTS
Studies have shown that antifungal agents can be of benefit in treating the elderly, children, and immunocompromised individuals (e.g., transplant patients, Down's patients, HIV patients, and diabetics) with onychomycosis.


CONCLUSIONS
The treatment modality of onychomycosis in special patient populations should take into account the clinical presentation of the onychomycosis, the causative organism, patient and physician preference, the concomitant medications that the patient is on, and the potential for adverse events for that patient if antifungal therapy is undertaken.
Gupta
Aditya K
AK
Division of Dermatology, Department of Medicine, Sunnybrook and Women's College Health Science Center (Sunnybrook site) and the University of Toronto, Toronto, Ontario, Canada. agupta@execulink.com
Ryder
Jennifer E
JE
Skinner
Alayne R
AR
D000284:Administration, Oral; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004347:Drug Interactions; D006801:Humans; D016867:Immunocompromised Host; D014009:Onychomycosis / Q000188:drug therapy* / Q000453:epidemiology; D016896:Treatment Outcome
D000935:Antifungal Agents