Both oral and topical treatments effective for fungal infection of nail

A recent review published in the British Journal of Dermatology finds both topical and oral treatments to be safe and effective for toenail onychomycosis -- a fungal infection of the nail caused by dermatophytes, yeasts and non‐dermatophyte molds. Onychomycosis accounts for approximately 50% of all nail related disease.

The researchers conducted a literature search for randomized controlled trials (RCTs) that included patients ≥18 years old where (fluconazole, itraconazole, terbinafine), topical (ciclopirox, efinaconazole, tavaborole), or device-based treatments were used both as monotherapy and in combination with other therapies. Of 77 randomized controlled trials, 26 were included in the network meta‐analysis (8,136 patients).

Outcomes included mycological cure, complete cure, treatment success, adverse events, and quality of life, while safety was evaluated by determining the number of patients who experienced at least 1 adverse event.

• There were no significant inconsistencies between direct and indirect evidence.


• Relative effects show that odds of mycological cure with continuous terbinafine 250 mg or continuous itraconazole 200 mg are significantly greater than topical treatments.


• Fluconazole, pulse regimens of terbinafine and itraconazole, and topical treatments did not differ significantly in odds of achieving mycological cure.


• The odds ratios of adverse events occurring with oral or topical treatments were not significantly different from each other.


• For mycological cure, evidence was of moderate or high quality while evidence ranged from very low to high quality for adverse events.

Analysis of the data also found no significant difference in the occurrence of adverse events in patients treated with oral vs topical therapy. “The risk of adverse events is similar across treatments with a caveat for clinicians to consult product inserts for warnings and precautions and choose the treatment that best suits their patients’ needs,” the authors noted.