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Onychomycosis - nail fungus
Commercial products to treat onychomycosis include griseoflulvin, itraconazole, terbinafine and circlopirox 8% nail lacquer. Griseofulvin has reported poor cure rates and requires 10 – 18 months of use. Oral therapy with itraconazole and terbinafine also present problems with drug interactions and liver toxicity. A patient with compromised liver function or a GERD patient on a PPI may not be a candidate for oral antifungals. For patients who cannot use antifungals, ciclopirox lacquer is the only commercial topical treatment available, however, it reportedly has only a 14% cure rate after several months of use. Having a compounded prescription medication may overcome these problems and avoid the need for extensive liver monitoring. We can dissolve an antifungal in a penetrating base with dimethylsulfoxide (DMSO) that has superior nail penetration and it is able to deliver an antifungal to the site of infection. Examples of antifungals that can be compounded in DMSO are azole antifungals and terbinafine.
Possible formulas

Mild to Moderate

Severe/Thickened Nail

Rx
Itraconazole 1% OR
Ketoconazole 2% OR
Terbinafine 5%
with
Ibuprofen 2%
DMSO 30%

30mL
Apply to affected nails BID
for a minimum of 14 weeks

Rx
Itraconazole 1% OR
Ketoconazole 2% OR
Terbinafine 5%
with
Undecylenic Acid 17%
DMSO/Tea Tree Oil 60%

30mL
Apply to affected nails BID
for a minimum of 14 weeks

Onychomycosis Abstract
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