Topical and systemic therapy for onychomycosis: modern approaches and drug selection

Abstract

This article presents a clinical-pharmacological overview of current approaches to treating onychomycosis, the most common fungal nail infection, with a global prevalence of approximately 4–5.5%. It examines the epidemiology, etiological profile (characterized by the predominance of Trichophyton rubrum and an increasing proportion of non-dermatophyte molds), risk factors, and key mechanisms of pathogen resistance, including the spread of Trichophyton indotineae, which exhibits terbinafine resistance rates of up to 70%. Regimens for local (lacquers, solutions, creams) and systemic therapy (terbinafine, itraconazole, fluconazole) are analyzed in detail, along with criteria for drug selection based on clinical form, severity of infection, and comorbidities. Particular attention is paid to treating specific patient groups, such as children, the elderly, and patients with diabetes or immunosuppression, as well as to safety monitoring principles for systemic antifungal therapy. The necessity of a combined approach, including mandatory debridement and footwear disinfection, to achieve lasting cure and prevent recurrence is emphasized.