Tioconazole 283mg/ml medicated nail lacquer

Abstract Treatment of onychomycosis includes topical and systemic agents. However, prolonged use of oral treatment could cause adverse effects and topical antifungal agents have limited penetration. To compare the clinical efficacy and the safety of fractional CO2 laser combined with topical tioconazole nail solution versus Q-switched 1064 Nd: YAG laser in the treatment of fingernail onychomycosis. This randomized comparative clinical trial was conducted on 13 patients (47 nails) with fingernail onychomycosis. Patients were randomized to receive either fractional CO2 laser combined with topical tioconazole or Q-Switched Nd: YAG 1064 nm laser every 2 weeks for 3 months followed by a 1-month follow up assessment. Onychomycosis severity index (OSI) score, Dermatology life Quality Index (DLQI) score, patient satisfaction score, dermoscopic evaluation and KOH examination were used for assessment of improvement. OSI showed improvement after treatment in both arms (from 16.17 to 10.92 in fractional CO2 arm ( p  = 0.026) and 23.13 to 22.43 ( p  = 0.92)). When comparing both groups OSI score significantly reduced in the fractional CO2 laser combined with tioconazole more than the Q-switched laser group (p = 0.002). The mean DLQI score significantly improved in both groups but no statistically significant difference between the two groups. Significant improvement in patient satisfaction score was noted in both groups. Mycological cure using KOH examination was detected in both groups (44.4% in the CO2 group and 56.5% in the Q-switched group) with no significant difference (P value < 0.05). Ruin pattern keratosis found to be the most dermoscopic pattern to be associated with poor OSI score improvement. Fractional CO2 laser combined with topical tioconazole is more efficient in treatment of onychomycosis than Q-Switched Nd: YAG 1064 nm laser group as regards clinical improvement but both have comparable effect on mycological cure. Their use as adjuvant treatment rather than alone is recommended to ensure mycological cure in onychomycosis.

Abstract licence: CC BY 4.0

The purpose of this review is to consolidate and summarize laser-assisted drug delivery (LADD) for nail diseases, particularly onychomycosis and psoriasis. A PubMed search was conducted in June 2023 using search terms (1) "laser assisted drug delivery" AND "nail," (2) "laser" AND "nail," and (3) "nail disorder" AND "laser treatment." References of papers were also reviewed, yielding 15 papers for this review. Fractional ablative CO2 laser (FACL) and Er:YAG laser can be used for LADD of topical medications such as amorolfine, terbinafine, and tioconazole to treat onychomycosis. A fungal culture should be performed to determine the type of dermatophyte, which will help determine which topical will be most effective. Laser settings varied between studies, but overall LADD tended to be more effective than topical treatments alone. Laser-assisted photodynamic therapy (PDT) was also found to be effective in treating onychomycosis. For psoriatic nails, LADD was used to deliver calcipotriol-betamethasone dipropionate foam, tazarotene, triamcinolone, or methotrexate into the nail. Again, LADD was found to be significantly more effective than topical treatment alone. FACL was the only laser noted for use for LADD in both diseases. Laser-assisted drug delivery for nail disease is a newer approach for onychomycosis and nail psoriasis with several benefits and drawbacks. Dermatologists should discuss the option of LADD with their patients who have recalcitrant onychomycosis or nail psoriasis.

Abstract licence: CC BY

Tioconazole (TCZ) is a broad-spectrum fungicidal BCS class II drug with reported activity against Candida albicans, dermatophytes, and certain Staphylococci bacteria. We report the use of TCZ-loaded transethosomes (TEs) to overcome the skin’s barrier function. TCZ-loaded TEs were fabricated by using a cold method with slight modification. Box–Behnken composite design was utilized to investigate the effect of independent variables. The fabricated TEs were assessed with various physicochemical characterizations. The optimized formulation of TCZ-loaded TEs was incorporated into gel and evaluated for pH, conductivity, drug content, spreadability, rheology, in vitro permeation, ex vivo permeation, and in vitro and in vivo antifungal activity. The fabricated TCZ-loaded TEs had a % EE of 60.56 to 86.13, with particle sizes ranging from 219.1 to 757.1 nm. The SEM images showed spherically shaped vesicles. The % drug permeation was between 77.01 and 92.03. The kinetic analysis of all release profiles followed Higuchi’s diffusion model. The FTIR, DSC, and XRD analysis showed no significant chemical interactions between the drug and excipients. A significantly higher antifungal activity was observed for TCZ-loaded transethosomal gel in comparison to the control. The in vivo antifungal study on albino rats indicated that TCZ-loaded transethosomal gel showed a comparable therapeutic effect in comparison to the market brand Canesten®. Molecular docking demonstrated that the TCZ in the TE composition was surrounded by hydrophobic excipients with increased overall hydrophobicity and better permeation. Therefore, TCZ in the form of transethosomal gel can serve as an effective drug delivery system, having the ability to penetrate the skin and overcome the stratum corneum barrier with improved efficacy.

Abstract licence: CC BY 4.0