Toenail onychomycosis:
highly prevalent and challenging to treat1-5

  • Onychomycosis is a common, progressive fungal infection of the nail that can eventually destroy the nail plate6-8

~90% of onychomycosis cases are caused by dermatophytes, most notably Trichophyton rubrum and Trichophyton mentagrophytes9


90% of onychomycosis is caused by dermatophytes like Trichophyton rubrum

Trichophyton rubrum

90% of onychomycosis is caused by dermatophytes like Trichophyton mentagrophytes

Trichophyton mentagrophytes

  • Even after successful treatment, clinical recurrence may occur in 21% to 48% of patients. Risk factors for recurrence may include8,10,11:
  • Concomitant disease
  • Tinea pedis
  • Genetic factors
  • Immunosuppression
  • Incorrect dosing or duration of treatment
  • Moisture
  • Wearing occlusive footwear
  • Older age
  • Poor hygiene
  • Trauma

References: 1. Ghannoum MA, Hajjeh RA, Scher R, et al. A large-scale North American study of fungal isolates from nails: the frequency of onychomycosis, fungal distribution, and antifungal susceptibility patterns. Am Acad Dermatol. 2000;43(4):641-648. 2. Elewski BE, Tosti A. Tavaborole for the treatment of onychomycosis. Expert Opin Pharmacother. 2014;15(10):1439-1448. 3. US Census Bureau. US summary: 2000. https://www.census.gov/prod/2002pubs/c2kprof00-us.pdf. Published July 2002. Accessed March 20, 2017. 4. Onychomycosis. In: Usatine RP, Smith MA, Chumley HS, Mayeaux EJ, eds. The Color Atlas of Family Medicine. 2nd ed. China: The McGraw-Hill Companies, Inc; 2013: 1-12. http://accessmedicine.mhmedical.com/content.aspx?bookid=685&sectionid=45361264. Accessed March 20, 2017. 5. Rodgers P, Bassler M. Treating onychomycosis. Am Fam Physician. 2001;63(4):663-672. 6. Fungal nail infections. Centers for Disease Control and Prevention website. http://www.cdc.gov/fungal/nail-infections.html. Accessed March 27, 2015. 7. Elewski BE, Rich P, Tosti A, et al. Onychomycosis: an overview. J Drugs Dermatol. 2013;12(7):s96-s103. 8. Westerberg DP, Voyack MJ. Onychomycosis: current trends in diagnosis and treatment. Am Fam Physician. 2013;88(11):762-770. 9. Gupta AK, Jain HC, Lynde CW, et al. Prevalence and epidemiology of onychomycosis in patients visiting physicians’ offices: a multicenter Canadian survey of 15,000 patients. J Am Acad Dermatol. 2000;43(2 Pt 1):244-248. 10. Sigurgeirsson B, Olafsson JH, Steinsson JB, et al. Long-term effectiveness of treatment with terbinafine vs itraconazole in onychomycosis: a 5-year blinded prospective follow-up study. Arch Dermatol. 2002;138(3):353-357. 11. Scher RK, Baran R. Onychomycosis in clinical practice: factors contributing to recurrence. Br J Dermatol. 2003;149(Suppl. 65):5-9.

Epidemiology of onychomycosis

Onychomycosis affects as many as 35 million North Americans

Onychomycosis affects about
35 million people
in the United States1-3

Onychomycosis occurs in one out of ten people

Onychomycosis occurs in about 
1 out of 10 people1-3

Toenails are affected by onychomycosis four times more than fingernails

Toenails are affected more often than fingernails4

50% of adults aged 70 years and older are affected by onychomycosis

45% of adults older than 65 years are affected5

References: 1. Ghannoum MA, Hajjeh RA, Scher R, et al. A large-scale North American study of fungal isolates from nails: the frequency of onychomycosis, fungal distribution, and antifungal susceptibility patterns. Am Acad Dermatol. 2000;43(4):641-648. 2. Elewski BE, Tosti A. Tavaborole for the treatment of onychomycosis. Expert Opin Pharmacother. 2014;15(10):1439-1448. 3. US Census Bureau. US summary: 2000. https://www.census.gov/prod/2002pubs/c2kprof00-us.pdf. Published July 2002. Accessed March 20, 2017. 4. Westerberg DP, Voyack MJ. Onychomycosis: current trends in diagnosis and treatment. Am Fam Physician. 2013;88(11):762-770. 5. Roseeuw D. Achilles foot screening project: preliminary results of patients screened by dermatologists. J Eur Acad Dermatol Venereol. 1999;12(Suppl. 1):S6-9.

Risk factors for onychomycosis

Some individuals are more likely to be infected with onychomycosis.

Genetic, behavioral, and
environmental factors
1-5

  • Family members with onychomycosis
  • Age ≥50 years
  • Smoking
  • Wearing occlusive footwear
  • Shared bathing facilities
  • History of nail trauma

Chronic disorders1,6,7

  • Gastrointestinal disease
  • Diabetes
  • Primary immunosuppression (HIV/AIDS)
  • Secondary immunosuppression (rheumatic disease, cancer)

Pre-existing atopic, skin, and fungal disorders1

  • Angioedema
  • Urticaria
  • Asthma
  • Psoriasis
  • Existing fungus infection such as tinea pedis

The risk of onychomycosis is about double in people with diabetes compared with the general population.6,8

References: 1. Sigurgeirsson B, Steingrímsson O. Risk factors associated with onychomycosis. J Eur Acad Dermatol Venereol. 2004;18(1):48-51. 2. Ameen M, Lear JT, Madan V, Mohd Mustapa MF, Richardson M. British Association of Dermatologists’ guidelines for the management of onychomycosis 2014. Br J Dermatol. 2014;171(5):937-958. 3. Gupta AK, Gupta MA, Summerbell RC, et al. The epidemiology of onychomycosis: possible role of smoking and peripheral arterial disease. J Eur Acad Dermatol Venereol. 2000;14(6):466-469. 4. Onychomycosis. In: Usatine RP, Smith MA, Chumley HS, Mayeaux EJ, eds. The Color Atlas of Family Medicine. 2nd ed. China:The McGraw-Hill Companies, Inc; 2013:1-12. http://accessmedicine.mhmedical.com/content.aspx?bookid=685&sectionid=45361264. Accessed March 20, 2017. 5. Elewski BE. Onychomycosis: pathogenesis, diagnosis, and management. Clin Microbiol Rev. 1998;11(3):415-429. 6. Gupta AK, Konnikov N, MacDonald P, et al. Prevalence and epidemiology of toenail onychomycosis in diabetic subjects: a multicentre survey. Br J Dermatol. 1998;139(4):665-671. 7. Cribier B, Mena ML, Rey D, et al. Nail changes in patients infected with human immunodeficiency virus: a prospective controlled study. Arch Dermatol. 1998;134(10):1216-1220. 8. Ghannoum MA, Hajjeh RA, Scher R, et al. A large-scale North American study of fungal isolates from nails: the frequency of onychomycosis, fungal distribution, and antifungal susceptibility patterns. Am Acad Dermatol. 2000;43(4):641-648.

Signs and symptoms of toenail onychomycosis

Accumulated hyperkeratotic debris, thickened subungual region, yellow-white or brown-black discoloration of nails caused by onychomycosis
  • Accumulated hyperkeratotic debris with resultant onycholysis1
  • Thickened subungual region2
  • Chipped and/or dystrophic nails1
  • Yellow-white or brown-black discoloration of the nails1

References: 1. Westerberg DP, Voyack MJ. Onychomycosis: current trends in diagnosis and treatment. Am Fam Physician. 2013;88(11):762-770. 2. Elewski BE. Onychomycosis: pathogenesis, diagnosis, and management. Clin Microbiol Rev. 1998;11(3):415-429.

Important Safety Information

KERYDIN® is for topical use only and not for oral, ophthalmic, or intravaginal use. The most commonly reported adverse events involved skin reactions in the application area, including exfoliation, ingrown toenail, erythema, and dermatitis.

Safety and effectiveness have not been established in pregnant or breastfeeding women or pediatric patients.

See Full Prescribing Information for KERYDIN®.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.FDA.gov/medwatch or call 1-800-FDA-1088.

Indication

KERYDIN® is an oxaborole antifungal indicated for the topical treatment of onychomycosis of the toenails due to Trichophyton rubrum or Trichophyton mentagrophytes.

Important Safety Information

KERYDIN® is for topical use only and not for oral, ophthalmic, or intravaginal use. The most commonly reported adverse events involved skin reactions in the application area, including exfoliation, ingrown toenail, erythema, and dermatitis.

Safety and effectiveness have not been established in pregnant or breastfeeding women or pediatric patients.

See Full Prescribing Information for KERYDIN®.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.FDA.gov/medwatch or call 1-800-FDA-1088.

Indication

KERYDIN® is an oxaborole antifungal indicated for the topical treatment of onychomycosis of the toenails due to Trichophyton rubrum or Trichophyton mentagrophytes.

Rotate your phone for Important Safety Information.