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The Latest on Onychomycosis Treatments

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Speaker: Shari R Lipner, MD PhD

What’s a new method to diagnose onychomycosis?

Basically, we can use PCR to amplify fungal DNA and make an accurate diagnosis of onychomycosis, so I think it’s really an exciting time.

These results also come very quickly: We can see results within 24 to 48 hours depending on your lab, so the patient can be treated within the next couple of days. Now, of course PCR will amplify any DNA, which is problematic. But by pairing your PCR technique along with one of the other existing techniques like KOH, PAS or culture, you can make an accurate diagnosis of onychomycosis

What’s a common comorbidity that affects your treatment of onychomycosis?

It’s not enough just to treat the nail topically for onychomycosis. A lot of these patients also have tinea pedis whether they know it or not, so you have to treat both the nail and the feet concurrently for better efficacy.

What’s the new data on the efficacy of lasers for the treatment of onychomycosis?

A recent systematic review looked at a comparison of laser studies along with medication studies looking at common endpoints. In one of these reviews, they looked at mycological cure and saw that the lasers only had an 11% mycological cure. Well, I don’t think that’d be acceptable to many of our patients, so probably lasers really need to be second line for treatment of onychomycosis after treatment with FDA-approved systemic or topical options first.

What treatments are you researching for onychomychosis?

Something we’re looking at is plasma treatment of onychomycosis. Basically, using ionized gas in vitro works to kill trichophyton rubrum. In our study on 19 patients with onychomycosis, this device was shown to have a clinical cure of about 50% and a mycological cure of about 19%.

Now, this was a pin device — we’re now looking at a patch device which just sits on the nail, so we think it’ll be more efficacious but we’re currently working on those clinical trials.

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