{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T21:51:34Z","timestamp":1793656294914,"version":"4.5.1"},"reference-count":101,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T00:00:00Z","timestamp":1732579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Onychomycosis is a nail infection caused by dermatophyte fungi, non-dermatophyte fungi, and yeast. Patients with chronic kidney disease on dialysis are part of the population that presents higher rates of this disease, mainly due to immunosuppression. Among patients with chronic kidney disease on dialysis, the treatment of onychomycosis is complex, mainly due to the limitations imposed by comorbidities. In this context, the study evaluated the safety and potential efficacy of a treatment that combines nail debridement with the use of acrylic gel nails carrying terbinafine at a concentration of 2%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients from the Hemodialysis Center of the S\u00e3o Francisco de Assis University Hospital in Bragan\u00e7a Paulista, S\u00e3o Paulo, Brazil were included. Those had hallux onychomycosis with clinical forms whose treatment involved the need for nail debridement. After the debridement procedure, a nail prosthesis made with acrylic reconstruction gel and 2% terbinafine was applied. The procedure was renewed every 2\u2009weeks (~14\u2009days) for 11\u2009months. The evolution was monitored with measurements of the normal-appearing nail plate and photographs. Direct mycological examination and fungal culture were performed at the beginning of the study and 30\u2009days after applications were interrupted. Assessment of clinical response, clinical cure, mycological cure, and complete cure was performed at the end of the study. All participants answered a questionnaire about their perception of the treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Out of the 155 patients on hemodialysis, 64\/155 (41.3%) individuals were identified with symptoms suggestive of onychomycosis in the halluces after clinical analysis. Among them, 35\/64 (54.7%) individuals presented a positive direct mycological examination and underwent fungal culture to identify the etiological agent. In this group of patients, 24\/35 (68.6%) individuals who presented clinical forms whose treatment involved the need for nail debridement were selected. Only 15\/24 (62.5%) individuals completed the study. Among the study participants, 5\/15 (33.3%) still presented positive fungal culture in the presence of a negative direct mycological examination and 1\/15 (6.7%) presented a positive direct mycological examination, but with a negative culture. Among those with a positive fungal culture, 3\/15 (20.0%) participants presented microorganisms different from those isolated in the initial exams. Regarding cure, 5\/15 (33.3%) participants showed a clinical response, 4\/15 (26.7%) clinical cure, and 3\/15 (20.0%) complete cure. No patient presented an allergic reaction or local irritation caused by the material used in the treatment. There were accidental superficial ulcerations caused by the electric sandpaper; however, no wound developed secondary infection. No participant reported discomfort due to the nail prosthesis use, 3\/15 (20.0%) reported a feeling of discomfort caused by the vibration of the electric file and 12\/15 (80.0%) reported the perception that their nails had a better appearance during treatment with nail prosthesis made with acrylic reconstruction gel and 2% terbinafine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The application of 2% terbinafine in acrylic reconstruction gel for the manufacture of nail prostheses applied after debridement of moderate and severe forms of onychomycosis showed low efficacy as an isolated treatment in patients on dialysis due to chronic kidney disease. On the other hand, most patients had a good perception of the appearance of their nails during treatment, even when it did not result in apparent clinical improvement or complete cure.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2024.1417985","type":"journal-article","created":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T04:23:45Z","timestamp":1732595025000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Terbinafine in acrylic polymer for the treatment of onychomycosis in hemodialysis patients: a phase II clinical trial"],"prefix":"10.3389","volume":"11","author":[{"given":"Jeanne Marie Queiroz Borges","family":"Bersano","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matheus Gobbo","family":"Cordeiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliana Mozer","family":"Sciani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iara L\u00facia","family":"Tescarollo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando Augusto Lima","family":"Marson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,11,26]]},"reference":[{"key":"ref1","volume-title":"Onychomycosis","author":"Bodman","year":"2024"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"559","DOI":"10.3390\/jof9050559","article-title":"Onychomycosis: old and new","volume":"9","author":"Maskan Bermudez","year":"2023","journal-title":"J Fungi (Basel)."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1268324","DOI":"10.3389\/fmed.2023.1268324","article-title":"Prevalence and risk predictors of onychomycosis in patients on hemodialysis: an observation, prospective, and unicenter study in Brazil","volume":"10","author":"Bersano","year":"2023","journal-title":"Front Med (Lausanne)."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1972","DOI":"10.1111\/jdv.16394","article-title":"Onychomycosis: a review","volume":"34","author":"Gupta","year":"2020","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1177\/1203475417716362","article-title":"Onychomycosis in the 21st century: an update on diagnosis, epidemiology, and treatment","volume":"21","author":"Gupta","year":"2017","journal-title":"J Cutan Med Surg"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1016\/j.jaad.2018.03.062","article-title":"Onychomycosis","volume":"80","author":"Lipner","year":"2019","journal-title":"J Am Acad Dermatol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1080\/07853890.2022.2044511","article-title":"Optimal diagnosis and management of common nail disorders","volume":"54","author":"Lee","year":"2022","journal-title":"Ann Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1007\/s40266-021-00917-8","article-title":"Onychomycosis in older adults: prevalence, diagnosis, and management","volume":"39","author":"Gupta","year":"2022","journal-title":"Drugs Aging"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1111\/jdv.18638","article-title":"Strategies for the enhancement of nail plate permeation of drugs to treat onychomycosis","volume":"37","author":"Gupta","year":"2023","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1016\/j.cpm.2021.06.004","article-title":"The penetrance of topical nail therapy: limitations and current enhancements","volume":"38","author":"Phan","year":"2021","journal-title":"Clin Podiatr Med Surg"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1016\/j.cpm.2021.06.005","article-title":"Biofilms and the nail unit","volume":"38","author":"Castillo","year":"2021","journal-title":"Clin Podiatr Med Surg"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"50","DOI":"10.23736\/S0392-0488.18.06001-7","article-title":"Evidence for biofilms in onychomycosis","volume":"154","author":"Gupta","year":"2019","journal-title":"G Ital Dermatol Venereol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"100949","DOI":"10.1016\/j.mycmed.2020.100949","article-title":"Treatment and management strategies of onychomycosis","volume":"30","author":"Aggarwal","year":"2020","journal-title":"J Mycol Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.1080\/14740338.2023.2280137","article-title":"The safety of oral antifungals for the treatment of onychomycosis","volume":"22","author":"Gupta","year":"2023","journal-title":"Expert Opin Drug Saf"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"32","DOI":"10.2174\/1872213X13666191026090713","article-title":"Onychomycosis: an updated review","volume":"14","author":"Leung","year":"2020","journal-title":"Recent Patents Inflamm Allergy Drug Discov"},{"key":"ref16","volume-title":"Terbinafine","author":"Maxfield","year":"2024"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1016\/S0009-9236(99)70065-2","article-title":"Investigation of terbinafine as a CYP2D6 inhibitor in vivo","volume":"65","author":"Abdelrahman","year":"1999","journal-title":"Clin Pharmacol Ther"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1395","DOI":"10.1080\/14740338.2020.1829592","article-title":"Safety of current therapies for onychomycosis","volume":"19","author":"Ricardo","year":"2020","journal-title":"Expert Opin Drug Saf"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e44914","DOI":"10.7759\/cureus.44914","article-title":"Retrospective analysis of liver enzyme abnormalities in patients prescribed Terbinafine and Itraconazole for onychomycosis","volume":"15","author":"Etg\u00fc","year":"2023","journal-title":"Cureus"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1080\/09546634.2019.1708242","article-title":"Retrospective analysis of adverse events with systemic onychomycosis medications reported to the United States Food and Drug Administration","volume":"32","author":"Wang","year":"2021","journal-title":"J Dermatolog Treat"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"114101","DOI":"10.1016\/j.fct.2023.114101","article-title":"Genetic variations of CYP3A4 on the metabolism of itraconazole in vitro","volume":"181","author":"Xie","year":"2023","journal-title":"Food Chem Toxicol"},{"key":"ref22","article-title":"Statin-induced rhabdomyolysis: a complication of a commonly overlooked drug interaction. Oxf med case reports. 2018, omx104","author":"Ezad","year":"2018"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"11","DOI":"10.21542\/gcsp.2017.11","article-title":"Torsade de pointes and systemic azole antifungal agents: analysis of global spontaneous safety reports","volume":"2017","author":"Salem","year":"2017","journal-title":"Glob Cardiol Sci Pract"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1933","DOI":"10.2147\/CCID.S362635","article-title":"Updated perspectives on the diagnosis and Management of Onychomycosis","volume":"15","author":"Falotico","year":"2022","journal-title":"Clin Cosmet Investig Dermatol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1016\/j.jaad.2018.05.1260","article-title":"Onychomycosis","volume":"80","author":"Lipner","year":"2019","journal-title":"J Am Acad Dermatol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"651","DOI":"10.2174\/1389200215666141125121511","article-title":"Drug interactions between nine antifungal agents and drugs metabolized by human cytochromes P450","volume":"15","author":"Niwa","year":"2014","journal-title":"Curr Drug Metab"},{"key":"ref27","volume-title":"Fluconazole","author":"Govindarajan","year":"2024"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1177\/12034754231220931","article-title":"Medication associations with severe cutaneous adverse reactions: a case\/non-case analysis using the FDA adverse event reporting system","volume":"28","author":"Godfrey","year":"2024","journal-title":"J Cutan Med Surg"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1097\/WON.0000000000000556","article-title":"Onychomycosis","volume":"46","author":"Beuscher","year":"2019","journal-title":"J Wound Ostomy Continence Nurs"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"105640","DOI":"10.1016\/j.micpath.2022.105640","article-title":"Relevant insights into onychomycosis\u2019 pathogenesis related to the effectiveness topical treatment","volume":"169","author":"Costa","year":"2022","journal-title":"Microb Pathog"},{"key":"ref31","first-page":"367","article-title":"A timeline of onychomycosis therapy and future directions","volume":"18","author":"Geizhals","year":"2020","journal-title":"Skinmed"},{"key":"ref32","first-page":"359","article-title":"Onychomycosis: rapid evidence review","volume":"104","author":"Frazier","year":"2021","journal-title":"Am Fam Physician"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"742","DOI":"10.3390\/jof8070742","article-title":"Dermatophytomas: clinical overview and treatment","volume":"8","author":"Gupta","year":"2022","journal-title":"J Fungi (Basel)"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"101638","DOI":"10.1016\/j.hansur.2024.101638","article-title":"Onychomycosis","volume":"43","author":"Zaraa","year":"2024","journal-title":"Hand Surg Rehabil"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1159\/000512037","article-title":"Excellent response of Dermatophytoma and nail splitting to nail plate debridement plus topical Ciclopirox Olamine 1% solution","volume":"7","author":"Hm","year":"2021","journal-title":"Skin Appendage Disord"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1080\/09546630701243418","article-title":"Review of antifungal therapy and the severity index for assessing onychomycosis: part I","volume":"19","author":"Baran","year":"2008","journal-title":"J Dermatolog Treat"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"e39","DOI":"10.1016\/j.jaad.2019.05.069","article-title":"Painless technique for debridement of onychodystrophic nails","volume":"82","author":"Lin","year":"2020","journal-title":"J Am Acad Dermatol"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"279","DOI":"10.3390\/jof8030279","article-title":"Combination therapy should be reserved as second-line treatment of onychomycosis: a systematic review of onychomycosis clinical trials","volume":"8","author":"Falotico","year":"2022","journal-title":"J Fungi (Basel)."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"98","DOI":"10.29271\/jcpsp.2018.02.98","article-title":"Factors affecting dermatological manifestations in patients with end stage renal disease","volume":"28","author":"Anees","year":"2018","journal-title":"J Coll Physicians Surg Pak"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1111\/ajd.13686","article-title":"Onychomycosis in older adults: the age and associated factors affecting the complete cure rate","volume":"63","author":"Bunyaratavej","year":"2022","journal-title":"Australas J Dermatol"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"e25737","DOI":"10.1016\/j.heliyon.2024.e25737","article-title":"The prevalence of onychomycosis in patients with chronic renal failure undergoing dialysis: a cross-sectional study","volume":"10","author":"Eftekhari","year":"2024","journal-title":"Heliyon"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1159\/000475674","article-title":"Hemodialysis and kidney transplantation as predisposing conditions to onychomycosis","volume":"137","author":"Filho","year":"2017","journal-title":"Nephron"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1186\/1471-2334-7-102","article-title":"The prevalance, epidemiology and risk factors for onychomycosis in hemodialysis patients","volume":"7","author":"Kuvandik","year":"2007","journal-title":"BMC Infect Dis"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1111\/myc.13577","article-title":"Onychomycosis associated with diabetic foot syndrome: a systematic review","volume":"66","author":"Navarro-P\u00e9rez","year":"2023","journal-title":"Mycoses"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1111\/1346-8138.16991","article-title":"Risk factors for the development of tinea pedis and onychomycosis: real-world evidence from a single-podiatry center, large-scale database in Japan","volume":"51","author":"Ogawa","year":"2024","journal-title":"J Dermatol"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1038\/nrneph.2013.44","article-title":"Immune cell dysfunction and inflammation in end-stage renal disease","volume":"9","author":"Betjes","year":"2013","journal-title":"Nat Rev Nephrol"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1111\/jdi.13725","article-title":"Role of the adaptive immune system in diabetic kidney disease","volume":"13","author":"Kong","year":"2022","journal-title":"J Diabetes Investig"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1161\/CIRCRESAHA.122.321749","article-title":"Innate immunity system in patients with cardiovascular and kidney disease","volume":"132","author":"Zoccali","year":"2023","journal-title":"Circ Res"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1111\/nep.13996","article-title":"End stage renal disease has an early and continuous detrimental effect on regulatory T cells","volume":"27","author":"Sampani","year":"2022","journal-title":"Nephrology (Carlton)"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1007\/s00430-019-00596-8","article-title":"T-cell aging in end-stage renal disease: an evolving story with CMV","volume":"208","author":"Yang","year":"2019","journal-title":"Med Microbiol Immunol"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"6857","DOI":"10.1007\/s11033-021-06684-4","article-title":"Inflammatory markers in chronic kidney disease and end stage renal disease patients","volume":"48","author":"Zakaria","year":"2021","journal-title":"Mol Biol Rep"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"11453","DOI":"10.3390\/ijms222111453","article-title":"The pathogenesis of end-stage renal disease from the standpoint of the theory of general pathological processes of inflammation","volume":"22","author":"Gusev","year":"2021","journal-title":"Int J Mol Sci"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"152","DOI":"10.4110\/in.2017.17.3.152","article-title":"Dendritic cell dysfunction in patients with end-stage renal disease","volume":"17","author":"Kim","year":"2017","journal-title":"Immune Netw"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.1001\/archdermatol.2011.267","article-title":"A new classification system for grading the severity of onychomycosis: onychomycosis severity index","volume":"147","author":"Carney","year":"2011","journal-title":"Arch Dermatol"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"498","DOI":"10.3109\/09546634.2016.1161156","article-title":"How do we measure efficacy of therapy in onychomycosis: patient, physician, and regulatory perspectives","volume":"27","author":"Gupta","year":"2016","journal-title":"J Dermatolog Treat"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1186\/1757-1146-4-26","article-title":"Safety and efficacy of tinea pedis and onychomycosis treatment in people with diabetes: a systematic review","volume":"4","author":"Matricciani","year":"2011","journal-title":"J Foot Ankle Res"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1080\/14656566.2024.2305304","article-title":"Effectiveness and safety of oral terbinafine for dermatophyte distal subungual onychomycosis","volume":"25","author":"Gupta","year":"2024","journal-title":"Expert Opin Pharmacother"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1002\/bdd.2510160807","article-title":"Pharmacokinetics of terbinafine and of its five main metabolites in plasma and urine, following a single oral dose in healthy subjects","volume":"16","author":"Humbert","year":"1995","journal-title":"Biopharm Drug Dispos"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"2738","DOI":"10.1128\/AAC.39.12.2738","article-title":"Multiple-dose pharmacokinetics and distribution in tissue of terbinafine and metabolites","volume":"39","author":"Kovarik","year":"1995","journal-title":"Antimicrob Agents Chemother"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1111\/bjd.18155","article-title":"Monotherapy for toenail onychomycosis: a systematic review and network meta-analysis","volume":"182","author":"Gupta","year":"2020","journal-title":"Br J Dermatol"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1517\/14656566.1.2.287","article-title":"Itraconazole","volume":"1","author":"Pi\u00e9rard","year":"2000","journal-title":"Expert Opin Pharmacother"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1007\/s15010-017-1042-z","article-title":"Pharmacokinetics of antifungal drugs: practical implications for optimized treatment of patients","volume":"45","author":"Bellmann","year":"2017","journal-title":"Infection"},{"key":"ref63","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1046\/j.1365-2710.2001.00338.x","article-title":"Itraconazole oral solution and intravenous formulations: a review of pharmacokinetics and pharmacodynamics","volume":"26","author":"Willems","year":"2001","journal-title":"J Clin Pharm Ther"},{"key":"ref64","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1007\/BF00265934","article-title":"The pharmacokinetics of fluconazole during haemodialysis in uraemic patients","volume":"42","author":"Oono","year":"1992","journal-title":"Eur J Clin Pharmacol"},{"key":"ref65","doi-asserted-by":"publisher","first-page":"SF378719-SF378719s10","DOI":"10.36849\/JDD.8719","article-title":"Individual article: updated review of topical pharmaceuticals and complementary and alternative medications for the treatment of onychomycosis in both general and special populations in the United States","volume":"22","author":"Issa","year":"2023","journal-title":"J Drugs Dermatol"},{"key":"ref66","doi-asserted-by":"publisher","first-page":"e388","DOI":"10.1097\/MJT.0000000000000696","article-title":"Antifungal drug use for onychomycosis","volume":"26","author":"Thomas","year":"2019","journal-title":"Am J Ther"},{"key":"ref67","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/s0378-5173(01)00989-9","article-title":"Drug delivery to the nail following topical application","volume":"236","author":"Murdan","year":"2002","journal-title":"Int J Pharm"},{"key":"ref68","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1080\/14787210.2018.1544891","article-title":"Update on current approaches to diagnosis and treatment of onychomycosis","volume":"16","author":"Gupta","year":"2018","journal-title":"Expert Rev Anti-Infect Ther"},{"key":"ref69","doi-asserted-by":"publisher","first-page":"1076","DOI":"10.36849\/JDD.6291","article-title":"Therapeutic recommendations for the treatment of toenail onychomycosis in the US","volume":"20","author":"Lipner","year":"2021","journal-title":"J Drugs Dermatol"},{"key":"ref70","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1007\/s13346-012-0109-8","article-title":"Microemulsion-based antifungal gel delivery to nail for the treatment of onychomycosis: formulation, optimization, and efficacy studies","volume":"2","author":"Barot","year":"2012","journal-title":"Drug Deliv Transl Res"},{"key":"ref71","doi-asserted-by":"publisher","first-page":"206","DOI":"10.3390\/biomimetics7040206","article-title":"Itraconazole and Difluorinated-curcumin containing chitosan nanoparticle loaded hydrogel for amelioration of onychomycosis","volume":"7","author":"Kesharwani","year":"2022","journal-title":"Biomimetics (Basel)"},{"key":"ref72","doi-asserted-by":"publisher","first-page":"163","DOI":"10.3109\/08982104.2015.1067892","article-title":"Terbinafine hydrochloride loaded liposome film formulation for treatment of onychomycosis:in vitroandin vivoevaluation","volume":"26","author":"Tuncay Tanr\u0131verdi","year":"2016","journal-title":"J Liposome Res"},{"key":"ref73","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.2217\/fmb-2023-0079","article-title":"Micro- and nanoparticles as platforms for the treatment of fungal infections: present and future perspectives","volume":"18","author":"Valdez","year":"2023","journal-title":"Future Microbiol"},{"key":"ref74","doi-asserted-by":"publisher","first-page":"24","DOI":"10.2174\/2211738507666190228104031","article-title":"Novel drug delivery strategies for the treatment of onychomycosis","volume":"7","author":"Dhamoon","year":"2019","journal-title":"Pharm Nanotechnol"},{"key":"ref75","doi-asserted-by":"publisher","first-page":"5717","DOI":"10.1109\/EMBC.2018.8513552","article-title":"Ultrasound-enhanced Ciclopirox delivery for treatment of onychomycosis","volume":"2018","author":"Kline-Schoder","year":"2018","journal-title":"Annu Int Conf IEEE Eng Med Biol Soc"},{"key":"ref76","doi-asserted-by":"publisher","first-page":"1272","DOI":"10.1007\/s13346-022-01244-0","article-title":"Iontophoresis application for drug delivery in high resistivity membranes: nails and teeth","volume":"13","author":"Martins Andrade","year":"2023","journal-title":"Drug Deliv Transl Res"},{"key":"ref77","doi-asserted-by":"publisher","first-page":"2557","DOI":"10.1007\/s10103-022-03561-9","article-title":"Efficacy of laser therapy combined with topical antifungal agents for onychomycosis: a systematic review and meta-analysis of randomised controlled trials","volume":"37","author":"Zhang","year":"2022","journal-title":"Lasers Med Sci"},{"key":"ref78","doi-asserted-by":"publisher","first-page":"39","DOI":"10.18502\/cmm.2023.345062.1430","article-title":"Impact of onychomycosis on the quality of life of patients","volume":"9","author":"Debbagh","year":"2023","journal-title":"Curr Med Mycol"},{"key":"ref79","first-page":"52","article-title":"On the basis of sex: impact and treatment of toenail onychomycosis in female patients","volume":"16","author":"Lipner","year":"2023","journal-title":"J Clin Aesthet Dermatol"},{"key":"ref80","doi-asserted-by":"publisher","first-page":"1227","DOI":"10.1016\/j.jaad.2020.05.143","article-title":"Effect of onychomycosis and treatment on patient-reported quality-of-life outcomes: a systematic review","volume":"85","author":"Stewart","year":"2021","journal-title":"J Am Acad Dermatol"},{"key":"ref81","doi-asserted-by":"publisher","first-page":"620","DOI":"10.4103\/0378-6323.100579","article-title":"Subungual hyperkeratosis nail biopsy: a better diagnostic tool for onychomycosis","volume":"78","author":"Nagar","year":"2012","journal-title":"Indian J Dermatol Venereol Leprol"},{"key":"ref82","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1111\/j.1365-2133.2007.08014.x","article-title":"Combination of surgical avulsion and topical therapy for single nail onychomycosis: a randomized controlled trial","volume":"157","author":"Grover","year":"2007","journal-title":"Br J Dermatol"},{"key":"ref83","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1080\/09546630252775171","article-title":"An open, randomized, comparative study of oral fluconazole, itraconazole and terbinafine therapy in onychomycosis","volume":"13","author":"Arca","year":"2002","journal-title":"J Dermatolog Treat"},{"key":"ref84","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.ijpharm.2012.04.024","article-title":"The human nail--barrier characterisation and permeation enhancement","volume":"435","author":"Walters","year":"2012","journal-title":"Int J Pharm"},{"key":"ref85","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1111\/j.2042-7158.1983.tb04258.x","article-title":"Physicochemical characterization of the human nail: permeation pattern for water and the homologous alcohols and differences with respect to the stratum corneum","volume":"35","author":"Walters","year":"1983","journal-title":"J Pharm Pharmacol"},{"key":"ref86","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1007\/s13346-015-0259-6","article-title":"Transungual permeation: current insights","volume":"6","author":"Bhuptani","year":"2015","journal-title":"Drug Deliv Transl Res"},{"key":"ref87","doi-asserted-by":"publisher","first-page":"901","DOI":"10.3109\/03639045.2011.637931","article-title":"Ungual and transungual drug delivery","volume":"38","author":"Shivakumar","year":"2012","journal-title":"Drug Dev Ind Pharm"},{"key":"ref88","doi-asserted-by":"publisher","first-page":"848","DOI":"10.1111\/jdv.12862","article-title":"Finger and toenail onycholysis","volume":"29","author":"Zaias","year":"2015","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"ref89","doi-asserted-by":"publisher","first-page":"950358","DOI":"10.1155\/2014\/950358","article-title":"Hydroxypropyl- \u03b2 -cyclodextrin: a novel Transungual permeation enhancer for development of topical drug delivery system for onychomycosis","volume":"2014","author":"Chouhan","year":"2014","journal-title":"J Drug Deliv"},{"key":"ref90","doi-asserted-by":"publisher","first-page":"916","DOI":"10.1111\/ijd.15807","article-title":"Oral nail growth supplements: a comprehensive review","volume":"61","author":"Yousif","year":"2022","journal-title":"Int J Dermatol"},{"key":"ref91","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1016\/j.clindermatol.2021.05.009","article-title":"Nutrition and nail disease","volume":"39","author":"Muddasani","year":"2021","journal-title":"Clin Dermatol"},{"key":"ref92","doi-asserted-by":"publisher","first-page":"101527","DOI":"10.1016\/j.hansur.2023.01.011","article-title":"Congenital nail abnormalities","volume":"43","author":"Nahmani","year":"2024","journal-title":"Hand Surg Rehabil"},{"key":"ref93","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1016\/j.clindermatol.2013.06.018","article-title":"Nail abnormalities associated with systemic pathologies","volume":"31","author":"Zaiac","year":"2013","journal-title":"Clin Dermatol"},{"key":"ref94","doi-asserted-by":"publisher","first-page":"Article_3","DOI":"10.7547\/17-201","article-title":"Trichophyton rubrum DNA strains in patients with onychomycosis with persistent mixed infections involving a nondermatophyte Mold","volume":"110","author":"Gupta","year":"2020","journal-title":"J Am Podiatr Med Assoc"},{"key":"ref95","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1007\/s40257-020-00580-6","article-title":"The growing problem of antifungal resistance in onychomycosis and other superficial mycoses","volume":"22","author":"Gupta","year":"2021","journal-title":"Am J Clin Dermatol"},{"key":"ref96","doi-asserted-by":"publisher","first-page":"1628","DOI":"10.1111\/jdv.17240","article-title":"Nondermatophyte mould onychomycosis","volume":"35","author":"Gupta","year":"2021","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"ref97","doi-asserted-by":"publisher","first-page":"637216","DOI":"10.3389\/fmed.2021.637216","article-title":"Diagnosis of onychomycosis: from conventional techniques and Dermoscopy to artificial intelligence","volume":"8","author":"Lim","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"ref98","doi-asserted-by":"publisher","first-page":"40","DOI":"10.5114\/pdia.2014.40968","article-title":"Amorolfine vs. ciclopirox - lacquers for the treatment of onychomycosis","volume":"32","author":"Tabara","year":"2015","journal-title":"Postepy Dermatol Alergol"},{"key":"ref99","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1111\/1346-8138.14935","article-title":"Efficacy of long-term treatment with efinaconazole 10% solution in patients with onychomycosis, including severe cases: a multicenter, single-arm study","volume":"46","author":"Iozumi","year":"2019","journal-title":"J Dermatol"},{"key":"ref100","doi-asserted-by":"publisher","first-page":"1145","DOI":"10.1080\/17512433.2016.1206467","article-title":"Tavaborole - a treatment for onychomycosis of the toenails","volume":"9","author":"Gupta","year":"2016","journal-title":"Expert Rev Clin Pharmacol"},{"key":"ref101","doi-asserted-by":"publisher","first-page":"71","DOI":"10.3314\/mmj.19.006","article-title":"Characteristics and efficacy of two topical therapeutic agents for onychomycosis","volume":"60","author":"Kawai","year":"2019","journal-title":"Med Mycol J"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1417985\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T04:23:55Z","timestamp":1732595035000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1417985\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,26]]},"references-count":101,"alternative-id":["10.3389\/fmed.2024.1417985"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2024.1417985","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,26]]},"article-number":"1417985"}}