Antifungals for the treatment of fingernail fungus

 The Treatment Of Fingernail Fungus Infections 

The fungus causes the deterioration of the nail structure, changes its patterns, color, and shape.

Fungal nail infections are considered one of the biggest problems in dermatology.

Among the main causes are the high rate of therapeutic failure, the difficulties in the treatment, the long periods needed, the deficient diagnoses, and the mycological follow-up.


The changes experienced in the treatment of fingernail fungus infections have displaced the techniques of surgical avulsion and local master preparations, and have given way to the use of new antifungal agents, topical or oral use, or a combination of both due to both frequent reinfections and relapses as well as post-surgical effects.


In the treatment of fingernail fungus infections caused by dermatophyte fungi, the criteria for the potency or effectiveness of antifungals are important.

The treatment of the infection depends on the degree of acceptance of the assigned regimen and on the form of administration of the medication by the patient.

In addition to the different degree of sensitivity shown by the various types of etiological agents to the range of substances, it is necessary to consider the pattern of in vitro activity of antifungal agents.
The oral administration of some antifungals used topically is not possible due to the low absorption of this type of substances.

In other cases, substances with greater specificity, safety, and lower toxicity are required. Some of the antifungal agents to treat fungus under nails are as follows.

Azoles


The mechanism of action of this group of antifungals is based on the inhibition of the enzyme lanosterol demethylase, which induces a fungistatic effect that slows down the proliferation of the fungus, and much higher concentrations are needed to achieve the fungicidal effect.

Azole antifungals act more slowly when compared to polyenes and a greater selectivity for fungal membranes prevails, compared to that on the membranes of mammalian cells.

Tioconazole


Tioconazole is a broad-spectrum antifungal agent active against yeasts and filamentous fungi dermatophytes and non-dermatophytes. This antifungal agent can reduce the fungus symptoms significantly.

In fact, some doctors call it the best fungus cure. It has an activity profile superior to that of Miconazole.

Tioconazole is especially effective for the treatment of mycosis in which there are infections due to bacteria sensitive to this antifungal agent.

Although in Onychomycosis, the treatments applied in the form of lacquer have reduced adverse effects attributed more to the high concentration of the antifungal than to the lacquer.

Bifonazole


Bifonazole provides its broad spectrum of action in vitro that includes yeast, dimorphic fungi, and dermatophytes.

Its lipophilicity and also its reduced solubility in water mean that the efficacy is related to the high cutaneous retention time it has and its topical bioavailability together with a good tolerance as additional advantages.

Despite its efficacy through occlusive treatment, in vitro sensitivity results are clearly outweighed, not only by the new triazoles antifungals but also by other antifungals in the family that are used topically against dermatophyte fungi such as the case of sertaconazole.

Regardless of the fact that occlusive treatment is safe, especially in patients of pediatric age, some adverse effects are observed such as erosions, pain, and dermatitis attributable to adhesives.

Sertaconazole


Sertaconazole appears as one of the new specific formulations for the treatment of Onychomycosis in transparent self-adhesive patches.

One of the greatest benefits is the possibility of carrying out a single weekly application in treatments lasting between 6-12 months. This ensures greater fidelity to therapy and an increase in antifungal efficacy rates without any systemic absorption.

The concentrations obtained in the nail between 2-6 weeks after the applications are between 100-150 ng/mg and they are above those necessary to achieve the inhibition of fungi that cause fingernail fungus infection.


In conclusion, although research on antifungals has led to the emergence of new substances for treatment, currently available are far from being fully effective, so it is imperative to continue research on new drugs, new formulations, and new combinations, especially those with a greater capacity of penetration in the nail.


None of the existing treatment schemes has been shown to be highly effective in the treatment of fingernail fungus infection so that the cure rates are still far from 100% and the economic cost of treating infections caused by fungi in the nails in reduced levels.

Alternatives to conventional treatments based on sustained release antifungal systems, as well as the use of micro-abrasions and the use of lasers are especially innovative.