Clinical effectiveness of topical antifungal treatment in onychomycosis

BACKGROUND: Onychomycosis is the infection of the nails by fungi, dermatophytes, yeasts or non-dermatophyte molds. It is associated with a high rate of therapeutic failure (20-50%) due to resistance to different therapeutic agents. OBJECTIVE: To perform a systematic review of the literature to establish the clinical effectiveness of topical antifungals to treat onychomycosis. METHOD: A systematic review of the literature was carried out; original articles were included in English, Spanish and Portuguese, between 1999 and 2016, in five indexed databases. RESULTS: Eight studies were included, classified with a low and indeterminate risk of biases, and a quantitative summary of the results was made: the clinical effectiveness was higher in the 8% water soluble cyclopiroxolamin group vs the 5% amorolfine group with a duration of treatment between 9 and 12 months), as well as in the group of 10% topical efinaconazole solution vs placebo whose treatment time was 12 months and in the group of tavaborole topical solution at 5% vs placebo for 12 months. CONCLUSIONS: When the lamina is less than 60% compromised, in patients without immunosuppression, 8% water soluble cyclopiroxolamin lacquer is superior to 5% amorolfine lacquer, and efinaconazole solution at 10% and tavaborole topical solution at 5% are superior to placebo; however, the complete cure rates found were not greater than 40% in any study, during a maximum treatment time of 12 months.