New Topical Nail Lacquer
The recent warnings regarding oral agents have made a new topical nail lacquer more attractive. Ciclopirox (Penlac) 8% topical solution appears to exert its antifungal effect through chelation of iron and aluminum.[17] Fungal cells degrade peroxides within them through metal-dependent enzymatic reactions. When the enzymes are denied iron and aluminum, the result may be a lethal build-up of peroxides. In manufacturer-sponsored studies on patients with 20%-65% involvement of the nail plate of the large toe, ciclopirox demonstrated ability to produce a clear nail and negative mycology in 6%-9% of patients, whereas patients receiving placebo alone only cleared in 0%-1% of cases. Negative mycology alone was achieved for 29%-36% of patients, as opposed to 9%-11% who received placebo.
Ciclopirox solution is applied to affected fingernails and toenails and the surrounding skin. It is specifically indicated for mild/moderate infections that do not involve the lunula and that are due to Trichophyton rubrum. A professional also must remove the unattached, infected nails as often as every month. Patients should not take oral antifungal medications concomitantly.
Patients are directed to apply ciclopirox evenly to the entire nail plate and 5 mm of surrounding skin. If the nail is free of the nail bed, the patient should attempt to apply the product to the undersurface of the nail plate. A full course of therapy is considered to be 48 weeks. Nail polish should not be used during the course of therapy. Once weekly, the accumulated coatings should be removed with alcohol, and the patient should file and trim the nails.
US Pharmacist. 2001;26(10) © 2001 Jobson Publishing
Cite this: Nail Fungus: Disfiguring and Difficult to Treat - Medscape - Oct 01, 2001.
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