Nail & Skin Disorders

Spread the News About Onychomycosis

As nail techs, our interest in how to treat onychomycosis seems insatiable. We want to stay informed and update our client on new ways to treat this persistent problem. You’ll be glad to know topical treatments are already in the testing phase, and NAILS has all the details.

One of the frustrations with nail fungus, officially called onychomycosis, is that there doesn’t seem to be much consistency in treatment of cure among clients. Some clients beg, plead, and bribe techs to cover the infected area with an artificial nail or polish, even though their nails is yellow, thick, gooey, and separated from the nail bed halfway to the cuticle. Other clients insist upon removal at the first sign of an infection – even though it may be nothing more than dry, winter skin.

For the nail tech, then, it’s difficult to survey clients on what does or does not work. Many clients don’t go to a doctor for prescription medicine, preferring to us over-the-counter treatments or to dimply cut the nail back until the affected area grows out. Others do seek medical attention, but even among these clients, the treatments differ, so it’s hard for a tech to figure out which treatment works best. Plus, many oral treatments doctors prescribe have side effects that the client may not share with the tech, and so techs are left wondering|: How can I know so little about something I see so often?

Statistic show that onychomycosis is present in 3%-5% of all Americans. Broken down into age groups, the numbers are alarming. Approximately one in five adults aged 30-60 is affected. That number rockets to more than 40% in adults over 60. Considering that nail techs see hundreds of clients a month, it’d natural that you will come across a number of people infected with a nail fungus.

Existing treatment options

Most likely techs have heard about a number of over-the-counter treatments: vinegar, Vick’s VapoRub, Fung-Off, etc. most of these have no scientifically documented proof of effectiveness. Tea tree oil seems to be exception among over-the-counter treatments; tests published in the Journal of  Antimicrobial Chemotheraphy and the Journal of Family Practice indicate 100% tea tree oil is 18% effective to treat mild cases of onychomycosis.

A few prescription medications have made a name for themselves as effective treatments for onychomycosis. One is a topical treatment called ciclopirox (Penlac). Penlac is nail lacquer that is applied to the affected nail and to the skin surrounding the nail. It’s a 48-week treatment plan. The success rate for Penlac is an unimpressive 8%, according to the package insert included with the medication.

Other prescription treatments are oral. Two popular ones are terbinafine (lamisil) and itraconazole (Sporanox). You may have seen the ads for Lamisil on TV; it’s the drug with the little “Digger” mascot on the commercials. The second medication, Sporanox, uses a “pulse dosing” treatment where patients take one tablet twice a day for one week, then go off the treatment for three weeks, and then have one final week of treatment. Success rate for Sporanox are not as high as Lamisil, but is still be preferred treatment of some doctors for particular case.

The highest rate of success (90%0 is found by combination an oral treatment with a topical treatment. But if the success rate is so high, why are so many people running around with untreated onychomycosis?

There could be number of reasons for this: the treatment for nail fungus is long and tedious. Many people get frustrated at the seemingly ineffective treatment. Another problem is that some of the oral prescriptions have a pleasant side effect. Also, up until recently, insurance companies viewed onychomycosis as a cosmetic issue and encouraged patients to live with it knowing the medications needed to treat it could be more harmful than the condition.

However, as our population ages and more and more people suffer with onychomycosis, attitudes are changing. Insurance companies are beginning to cover prescription cost and doctors are viewing the condition as an infectious disease.

New on the Horizon

A number of companies are in the department stage of new treatments for onychomycosis. But why would companies spend money on research and development if current products already have a high success rate? Well, a number of reason, actually.

First, the most successful rates come from medications that are oral, not topical. When a treatment is ingested, it gets into the bloodstream. Once in the bloodstream. Once in the bloodstream, it moves through the liver, raising the possibility of live problems. Also, oral treatments can cause negative reactions when combined with other prescription medication. Since the highest rate of onychomycosis shows up in the senior population, it can be assumed that many patients in this age group will be on some form of prescription medication.

So the goal of this next generation of treatment is to provide a topical cure that penetrates the nail and gain access to the site of infection without also gaining access to the site of infection without also gaining access to vital organs and the bloodstream. At least three such medications have been developed and are in a testing phase, which is good news for people looking for a viable solution to their nail fungus.

The first is being developed by a company called NanoBio Corp., a privately-held biopharmaceutical company located in Ann Arbor, Mich. The before market name of their treatment is NB-002. NanoBio uses its own NanoStat technology allows a treatment such as NB-002 to be topically administered instead of systematically absorbed; the treatment is selectively toxic to microbes while non-irritating to the skin and mucous membranes.”

According to their press announcement, phase 1 testing involved 20 subjects who receive twice-daily treatments of MB-002 for 28 days. “Phase 1 safety data further confirms that NB-002 will offer a safe alternative to the current available systemic products, says Baker “this is a critical factor for individuals affected by onychomycosis, given approximately 95% of people with this disease associated with the oral medications on the market.” The company now begins phase 2 of testing.

Skin Treatment Applied to Nails

A second drug in the R&D phase is from a company called MacroChem. MacroChem has developed a new treatment for onychomycosis in the form of nail lacquer called Eco Nail. The active anti-fungal drug currently used to treat skin fungus. This drug hasn’t been effective as a nail fungal treatment because, as of yet, the drug has not been able to penetrate the nail. However, MacroChem has developed a technology called SEPA (Soft Enhancement of Percutaneous Absorption) that it says allows the drug to a company press release, “SEPA technology allows the active drug to penetrate the nail barrier and rest between the underside of the toenail and skin beneath the nail – where the fungus lives – to eradicate onychomycosis at the site of infection.” EcoNails is in Phase 2 of testing, which means it is currently being tested on the patients to determine its efficacy.

The final hope on the horizon comes from Anacor Pharmaceuticals, a privately held pharmaceutical company based in Paolo Alto, Calif. They have developed and tested a treatment with a before-market name of AN2690, which is well into its Phase 2 testing. Anacor announced this year that they have made a worldwide agreement with global pharmaceutical giant Schering Plough to commercialize AN2690.

“The result of Phase 2 findings suggest that the AN2690 is substantially more effective than other topical treatments,” said Raza Aly, Pd.D., adjunt professor in the departments of dermatology and microbiology immunology at the University of California at San Francisco. “The mycological findings clearly show that the drug kills fungus, and the consistent clear nail growth provides evidence of a real clinical benefit from the treatment.”

It may all sound a bit scientific for a nail tech in the beauty industry, but here it is in laymen’s term: A topical treatment for onychomycosis will be on the market in the near future, offering clients relief from unsightly and painful nail fungus without the side effects of the oral treatments used today. That’s good news no matter how you say it. 

Keywords:   antifungals     fungal infections     onychomycosis  



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