Onychomycosis: local pharmacokinetics and the future of topical antifungals

Topical treatment for onychomycosis gains momentum in dermatological practice as well as in antifungal formulations research pipeline. Decades of clinical use of internationally available antifungals bring no consensus on real clinical efficacy of topical monotherapy of fungal nail infection. Recommendations of national societies and expert bodies offer no clear guidance on principles and practice of combination therapy with systemic and topical antifungals. Clinical trials conducted to date indicate evidence-based superiority of naftifine 1% topical formulations in management of tinea pedis and onychomycosis. Recently, Russian and international authors evaluated the benefits of antifungal solutions in treatment of onychomycosis. New data on pathophysiology of fungal nail infection and local pharmacokinetics of drugs inside the affected nail elucidate the success of 1% solution of naftifine in topical treatment of onychomycosis.