Onychomycosis: Strategies to minimize recurrence

Aditya K. Gupta, Boni E. Elewski, Ted Rosen, Bryan Caldwell, David M. Pariser, Leon H. Kircik, Neal Bhatia, Antonella Tosti

Research output: Contribution to journalArticle

20 Scopus citations

Abstract

Recurrence (relapse or re-infection) in onychomycosis is common, occurring in 10% to 53% of patients. However, data on prevalence is limited as few clinical studies follow patients beyond 12 months. It has been suggested that recurrence after continuous terbinafine treatment may be less common than with intermittent or continuous itraconazole therapy, probably due to the fungicidal activity of terbinafine, although these differences tended not to be significant. Relapse rates also increase with time, peaking at month 36. Although a number of factors have been suggested to play a role in recurrence, only the coexistence of diabetes has been shown to have a significant impact. Data with topical therapy is sparse; a small study showed amorolfine prophylaxis may delay recurrence. High concentrations of efinaconazole have been reported in the nail two weeks’ post-treatment suggesting twice monthly prophylaxis with topical treatments may be a realistic option, and may be an important consideration in diabetic patients with onychomycosis. Data suggest that prophylaxis may need to be continued for up to three years for optimal effect. Treating tinea pedis and any immediate family members is also critical. Other preventative strategies include avoiding communal areas where infection can spread (such as swimming pools), and decontaminating footwear.

Original languageEnglish (US)
Pages (from-to)279-282
Number of pages4
JournalJournal of Drugs in Dermatology
Volume15
Issue number3
StatePublished - Mar 1 2016

ASJC Scopus subject areas

  • Medicine(all)
  • Dermatology

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    Gupta, A. K., Elewski, B. E., Rosen, T., Caldwell, B., Pariser, D. M., Kircik, L. H., Bhatia, N., & Tosti, A. (2016). Onychomycosis: Strategies to minimize recurrence. Journal of Drugs in Dermatology, 15(3), 279-282.