Topical Antifungal Agents Reduce Toenail Onychomycosis Recurrence

Toe fungus
Toe fungus
Patients with a family history of fungal infections should be closely monitored for recurrence.

The use of topical antifungal agents as prophylactic therapy following toenail onychomycosis reduces recurrence rates significantly, according to findings from a retrospective chart review published in Dermatologic Therapy.  

Data were collected from 320 patients (52% male; age 39-95 years) with toenail onychomycosis, who were treated initially with either oral terbinafine (250 mg/day) or pulse itraconazole (400 mg/day, 1 week on, 3 weeks off) for 3 to 4 months. Following a complete cure, a topical antifungal agent (amorolfine, bifonazole, ciclopirox olamine, or terbinafine spray) was used prophylactically on a weekly basis.

On average, patients presented with 2.4 affected toenails. For each participant, recurrence of toenail onychomycosis was recorded, along with family history of fungal infections, and presence of diabetes, immunosuppression, peripheral artery disease, psoriasis, smoking, and tinea pedis. The overall recurrence rate of toenail onychomycosis was 48.4% (156 of 320 participants).

Recurrence rates were significantly lower among patients receiving topical antifungal prophylactic treatment compared with those receiving no prophylactic therapy following the use of oral terbinafine (P <.001) but not itraconazole (P =.185). Regardless of which oral treatment was previously administered, the use of topical antifungal medications as prophylaxis significantly decreased the likelihood that recurrence would occur (P <.001). In contrast, the number of affected toenails (P =.048) and family history of fungal infections (P <.001) significantly increased the likelihood of recurrence.

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The findings support the use of topical antifungal medications for the prevention of toenail onychomycosis recurrence. The researchers recommend that those with a family history of fungal infections be monitored closely.


Shemer A, Gupta AK, Kamshov A, et al. Topical antifungal treatment prevents recurrence of toenail onychomycosis following cure [published online August 30, 2017]. Dermatol Ther. doi: 10.1111/dth.12545