• 1

    Scher RK, Coppa LM: Advances in the diagnosis and treatment of onychomycosis. Hosp Med 34: 11, 1998.

  • 2

    Crissey JT: Common dermatophyte infections. A simple diagnostic test and current management. Postgrad Med 103: 191, 1998.

  • 3

    Welsh O, Vera-Cabrera L, Welsh E: Onychomycosis. Clin Dermatol 28: 151, 2010.

  • 4

    Drake LA, Patrick DL, Fleckman P, et al.: The impact of onychomycosis on quality of life: development of an international onychomycosis questionnaire to measure patient quality of life. J Am Acad Dermatol 41: 189, 1999.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Scher RK: Onychomycosis: a significant medical disorder. J Am Acad Dermatol 352: S2, 1996.

  • 6

    Lubeck DP, Patrick DL, McNulty P, et al.: Quality of life of persons with onychomycosis. Qual Life Res 2: 341, 1993.

  • 7

    Finch JJ, Warshaw EM: Toenail onychomycosis: current and future treatment options. Dermatol Ther 20: 31, 2007.

  • 8

    Del Rosso JQ: Onychomycosis of toenails and post-hoc analyses with efinaconazole 10% solution once-daily treatment: impact of disease severity and other concomitant associated factors on selection of therapy and therapeutic outcomes. J Clin Aesthet Dermatol 9: 42, 2016.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Shirwaikar AA, Thomas T, Shirwaikar A, et al.: Treatment of onychomycosis: an update. Indian J Pharm Sci 70: 710, 2008.

  • 10

    Thomas J, Jacobson GA, Narkowicz CK, et al.: Toenail onychomycosis: an important global disease burden. J Clin Pharm Ther 35: 497, 2010.

  • 11

    Kawa N, Lee KC, Anderson RR, et al.: Onychomycosis: a review of new and emerging topical and device-based treatments. J Clin Aesthet Dermatol 12: 29, 2019.

  • 12

    Foley K, Gupta AK, Versteeg S, et al.: Topical and device-based treatments for fungal infections of the toenails. Cochrane Database Syst Rev 1: CD012093, 2020.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Aggarwal R, Targhotra M, Kumar B, et al.: Treatment and management strategies of onychomycosis. J Mycol Med 30: 100949, 2020.

  • 14

    Gupta AK, Daigle D, Foley KA: Network meta-analysis of onychomycosis treatments. Skin Appendage Disord 1: 74, 2015.

  • 15

    Gupta AK, Daigle D, Paquet M: Therapies for onychomycosis: a systematic review and network meta-analysis of mycological cure. JAPMA 105: 357, 2015.

  • 16

    Vlahovic TC, Joseph WS, Scher RK, et al.: Diagnosis and management of onychomycosis: perspectives from a joint podiatry-dermatology roundtable. JAPMA 106: 155, 2016.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Lipner SR, Scher RK: Efinaconazole 10% topical solution for the topical treatment of onychomycosis of the toenail. Expert Rev Clin Pharmacol 8: 719, 2015.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Sakamoto M, Sugimoto N, Kawabata H, et al.: Transungual delivery of efinaconazole: its deposition in the nail of onychomycosis patients and in vitro fungicidal activity in human nails. J Drugs Dermatol 13: 1388, 2014.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Zeichner JA, Stein-Gold L, Korotzer A: Penetration of (14C)-efinaconazole topical solution, 10%, does not appear to be influenced by nail polish. J Clin Aesthet Dermatol 7: 34, 2014.

    • Search Google Scholar
    • Export Citation
  • 20

    Del Rosso JQ: Application of nail polish during topical management of onychomycosis: are data available to guide the clinician about what to tell their patients? J Clin Aesthet Dermatol 9: 29, 2016.

    • Search Google Scholar
    • Export Citation
  • 21

    Ramakrishna T, Olin JT: Efinaconazole 10% solution in the treatment of toenail onychomycosis: two phase III multicenter, randomized, double-blind studies. J Am Acad Dermatol 68: 600, 2013.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Iozumi K, Abe M, Ito Y, et al.: Efficacy of long-term treatment with efinaconazole 10% solution in patients with onychomycosis, including severe cases: a multicenter, single-arm study. J Dermatol 46: 641, 2019.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Bodman M: Keys to managing severe onychomycosis. Podiatry Today 26: 46, 2013.

  • 24

    Sud A, Jones ME, Broggio J, et al.: Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic. Ann Oncol 31: 1065, 2020.

  • 25

    Mihaljevic T, Farrugia G: How many more will die from fear of the coronavirus? New York Times, June 9, 2020. Available at: https://www.nytimes.com/2020/06/09/opinion/coronavirus-hospitals-deaths.html. Accessed February 19, 2021.

    • Search Google Scholar
    • Export Citation
  • 26

    Solomon MD, McNulty EJ, Rana JS, et al.: The covid-19 pandemic and the incidence of acute myocardial infarction. N Engl J Med 383: 691, 2020.

  • 27

    Hay RJ, Baran R: Onychomycosis: a proposed revision of the clinical classification. J Am Acad Dermatol 65: 1219, 2011.

  • 28

    Vlahovic T, Borrelli A, Bruno J: How to address the disappearing nail bed. Podiatry Today 34: 26, 2021.

  • 29

    Jo Siu WJ, Tatsumi Y, Senda H, et al.: Comparison of in vitro antifungal activities of efinaconazole and currently available antifungal agents against a variety of pathogenic fungi associated with onychomycosis. Antimicrob Agents Chemother 57: 1610, 2013.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Lee BC, Pangeni R, Na J, et al.: Preparation and in vivo evaluation of a highly skin- and nail-permeable efinaconazole topical formulation for enhanced treatment of onychomycosis. Drug Deliv 26: 1167, 2019.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Gupta AK, Elewski BE, Sugarman JL, et al.: The efficacy and safety of efinaconazole 10% solution for treatment of mild to moderate onychomycosis: a pooled analysis of two phase 3 randomized trials. J Drugs Dermatol 13: 815, 2014.

    • PubMed
    • Search Google Scholar
    • Export Citation

Total Dystrophic Onychomycosis Successfully Treated with Efinaconazole Topical Solution in Times of Coronavirus Disease of 2019: A Case Study

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  • 1 Professional Foot Care Specialists PC, 5241 S Cicero Ave, Chicago, IL 60632. (E-mail: mggaro@aol.com)
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Toenail onychomycosis is a common condition that is equally challenging for podiatrists and patients. This case study documents a 26-year-old woman with bilateral total dystrophic onychomycosis of at least 5 years’ duration. She had previously failed to respond to treatment with ciclopirox nail lacquer 8% and, despite hiding her condition with nail polish, was suffering from embarrassment, distress, and low self-esteem. At initial consultation, 100% of both great toenails was affected. After discussion of all treatment options, the patient opted for topical efinaconazole 10% solution, once daily for 48 weeks. Significant improvement was noted at the first (4-week) assessment period. This improvement was maintained through each subsequent virtual consultation, and complete cure was seen at a 30-week follow-up visit. To the author’s knowledge, this is the first published report on the use of efinaconazole in total dystrophic onychomycosis. It suggests that the product may be effective in patients with even the most severe and treatment-recalcitrant disease, who are unwilling or unable to tolerate systemic antifungal therapy.