Efficacy of treatments against fungal infections

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Patients presenting with fungal conditions from thrush and candida to jock itch, fungal nail infections and athlete’s foot, which can range from annoying to debilitating, are the order of the day for pharmacies.

Dermatologist Associate Professor Alvin Chong, Director of Education at the Skin & Cancer Foundation, tells Retail Pharmacy that many antifungal treatments are on offer from pharmacies but not all of them are effective against certain fungal infections.

“Most cutaneous infections, which are just on the skin, can easily be treated with topical antifungals such as miconazole and terbinafine cream, but they seldom work for fungal nail infections,” he said.

“Despite this there are many topical therapies for sale in pharmacies directed toward nail disease, such as Rejuvenail and Loceryl.”

Rejuvenail, as an example, is a specially developed nail lacquer for the treatment of fungal infections of toenails and fingernails. The active ingredient ciclopirox is claimed to penetrate the nail to reach the site of fungal infection and prevent growth of the fungal infection by destroying the fungi that cause the nail infection.

“These types of medications are non-PBS subsidised and quite expensive: for example, a 6.6ml bottle of Rejuvenail retails at about $60 to $80 and treatment, which needs to take place daily, is for six to 12 months,” Dr Chong said.

“Even in the best study scenarios the cure rate is only 30%, so this is an area where pharmacists could definitely educate the public as to their prolonged nature and lack of efficacy.

“These topical fungal nail treatments only work well if a patient has a limited nail disease, ie, it’s quite superficial and it’s treated early on.”

He emphasises that nail disease that is extensive or span the whole thickness of the nail is difficult to treat with topical treatments and requires a GP consultation.