title: New therapeutic options for onychomycosis.
abstract: BACKGROUND
  Onychomycosis is a fungal infection of the nail apparatus that affects 10 - 30% of the global population. Current therapeutic options for onychomycosis have a low to moderate efficacy and result in a 20 - 25% rate of relapse and reinfection. New therapeutic options are needed to broaden the spectrum of treatment options and improve the efficacy of treatment.
  
  
  METHODS
  This review discusses the emerging pharmacotherapeutics; including topical reformulations of terbinafine, new azole molecules for systemic and topical administration, topical benzoxaboroles and topical polymer barriers. The paper also discusses device-based options, which may be designed to activate a drug or to improve drug delivery, such as photodynamic therapy and iontophoresis; laser device systems have also begun to receive regulatory approval for onychomycosis.
  
  
  CONCLUSIONS
  Device-based therapeutic options for onychomycosis are expanding more rapidly than pharmacotherapy. Systemic azoles are the only class of pharmacotherapy that has shown a comparable efficacy to systemic terbinafine; however terbinafine remains the gold standard. The most notable new topical drugs are tavaborole, efinaconazole and luliconazole, which belong to the benzoxaborole and azole classes of drugs. Photodynamic therapy, iontophoresis and laser therapy have shown positive initial results, but randomized controlled trials are necessary to determine the long-term success of these devices.
authors.affiliation: Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. agupta@execulink.com
authors.forename: Aditya K
authors.initials: AK
authors.lastname: Gupta
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Simpson
mesh_terms: D000499:Allylamine / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage*; D001393:Azoles / Q000008:administration & dosage; D001896:Boron Compounds / Q000008:administration & dosage; D019086:Bridged Bicyclo Compounds, Heterocyclic / Q000008:administration & dosage; D054714:Echinocandins / Q000008:administration & dosage; D006801:Humans; D007478:Iontophoresis; D007834:Lasers; D009281:Naphthalenes / Q000008:administration & dosage; D014009:Onychomycosis / Q000188:drug therapy*; D010778:Photochemotherapy; D011108:Polymers / Q000008:administration & dosage; D000077291:Terbinafine
chemical_list: D000935:Antifungal Agents; D001393:Azoles; D001896:Boron Compounds; D019086:Bridged Bicyclo Compounds, Heterocyclic; D054714:Echinocandins; D009281:Naphthalenes; D011108:Polymers; D000499:Allylamine; D000077291:Terbinafine