Next-generation Antifungal Drugs Hold Promise for Dermatophytoses, Newer Therapeutics Overcome Shortcomings of Early Drugs

Published Date : Jan 25, 2016

In the U.S., onychomycosis poses as a major public health problem, as it is prevalent in 10% of the population and its associated morbidity. Although not life-threatening, the fungal infection is a dermatophytic invasion of the nail plate. The infection can be present in any component of the nail unit, which includes the bed, matrix, or plate. Pain, discomfort, and disfigurement are the notable signs of onychomycosis, which may lead to significant physical and occupational limitations. The condition can also affect life quality significantly.

Dermatophytoses of Toenails- a Glance

Depending on the site and pattern of the fungal infection, onychomycosis is mainly of four types. Onychomycosis, predominantly caused by the dermatophyte fungi is also sometime related with yeasts and nondermatophyte molds. For the accurate diagnosis of the type of infection, direct microscopy and fungal culture is required. Psoriasis, onychogryphosis, lichen planus, and nail trauma are the conditions that differentiate the severity of onychomycosis. Of all the various types of dermatophytoses, onychomycosis is the most difficult to treat due to the slow growth of the nail inherently.

Due to the increasing prevalence of dermatophytic onychomycosis and the need for effective therapeutics, the line of treatment for the condition is consistently advancing. Ketoconazole and griseofulvin, the older antifungal agents have been replaced by recently developed agents, due to their poor efficacy and the potential to cause adverse effects. Itraconazole, terbinafine, and fluconazole are the newly developed antimycotic agents that offer high chances of cure and carry good safety profiles. 

How has treatment for Dermatophytoses Evolved?

In the instance of development of dermatophytoses of the toenails or fingernails, the disease is difficult to eradicate, in contrast if the disease develops in some other body part. Factors that are intrinsic to the nail, such as protective nail plate, slow growth of the nail, sequestration of pathogens in between the nail bed and plate, and relatively poor effectiveness of the earlier pharmacologic agents.

Nevertheless, in the recent years, the development of the next-generation antifungal drugs has led to produce impressive and long-lasting cure rates, which have the advantage of shorter time of treatment and improved safety profiles than the previously used griseofulvin and ketoconazole.