ADVANCES IN ANTIFUNGAL THERAPY FOR ONCHOMYCOSIS: A FOCUS ON EMERGING AGENTS AND TECHNOLOGIES

Onychomycosis, a persistent fungal infection of the nails, is a therapeutic challenge because of its high recurrence, poor drug penetration, and resistance developed by the fungus to common antifungals (AFs). “The available therapies, such as oral azoles and topicals, can have limited efficacy, lengthy duration of treatment, or potential side effects,” they added. This has created a demand for new and better AF tactics. Novel AFs whose development has been fueled by recent advances in our understanding about fungal biology are the newer (most are second-line for invasive mycoses) broad-spectrum systemic agents with superior pharmacokinetic profiles and lower toxicities, as seen with improved azole derivatives and allylamines. Systemic AF therapy nanotechnology-mediated drug delivery systems, such as nanoparticle encapsulated AFs and liposomal formulations, have promising potential for increased drug penetration and therapeutic efficacy. In resistant cases, non-pharmacological measures such as photodynamic therapy and lasers are increasingly being considered. In addition, emerging approaches, such as microbiome-targeted interventions and RNA-based treatments, provide new methods for addressing fungal biofilms and recalcitrant infections. However, significant challenges exist in the translation of these novel therapies into clinical practice, and research efforts continue to be made toward refining modifications of treatment algorithms and enhancing patient efficacy. The present review summarizes the new therapeutic approaches to onychomycosis with a special emphasis on the mechanism, clinical efficacy, and future development. The convergence of innovative anti-fibrotic agents (AFs), nanotechnology, and novel therapeutic approaches holds promise for the development of more efficacious and tolerable treatments in the near future.