Canadian Perspectives on Antifungal Treatment for Onychomycosis

Abstract

Onychomycosis is a common nail disease caused by dermatophytes, yeasts, and nondermatophyte molds affecting approximately 6.5% of the Canadian population. Approved therapies for onychomycosis in Canada are terbinafine 250 mg once daily for 6 to 12 weeks; itraconazole 200 mg twice daily given for two to three pulses (one pulse=200 mg daily for 1 week, with 3 weeks off the drug before the next pulse); and ciclopirox nail lacquer 8% used once daily for up to 48 weeks. These medications can be used for dermatophyte onychomycosis of toenails or fingernails. Liver enzyme monitoring should be performed when prescribing the oral medications. Ciclopirox is one of the newest antifungal agents and is the only topical therapy specifically indicated for onychomycosis in Canada. Topical therapy for onychomycosis provides an advantage over oral treatment in safety and cost, giving ciclopirox wide potential for use. It remains to be seen what future role ciclopirox will have in the Canadian onychomycosis spectrum.