A new article published in Journal of the European Academy of Dermatology and Venereology reported that onychomycosis – infection of the nail, was initially thought to be caused by dermatophytes; however, new research has revealed that mixed infections and those caused by non-dermatophyte molds (NDMs) are more prevalent than previously thought, especially in the warmer climates.

The authors stated that microscopy and fungal culture are gold standard techniques for onychomycosis diagnosis, but owing to their high false-negative rates, more accurate methods, such as histology and PCR are being preferred. As NDMs are skin and laboratory contaminants, their presence as an infectious agent requires multiple confirmations and repeated sampling. Treatment options for such infections include oral antifungals, topicals and devices. Topical treatments, such as efinaconazole, tavaborole, ciclopirox and amorolfine have less serious side effects, but also have generally lower cure rates and much longer treatment regimens.

Newer topical formulations are being investigated as faster-acting alternatives to the currently available topical treatments. Devices such as lasers have shown promise in improving the cosmetic appearance of the nail, but due to a high variation of study methods and definitions of cure, their effectiveness for onychomycosis has yet to be sufficiently proven.

Recurrence rates for onychomycosis are high; once infected, patients should seek medical treatment as soon as possible and sanitize their shoes and socks. Prophylactic application of topicals and avoiding walking barefeet in public places may help in preventing recurrence.

Source: Journal of the European Academy of Dermatology and Venereology. 2020 Apr 1. doi: 10.1111/jdv.16394.