Acitretin combined with itraconazole is effective against Onychomycosis

In a study led by Mohamed Nasr it was shown that Acitretin has the potential to be a potent therapeutic agent in the treatment of onychomycosis, with higher efficacy when combined with itraconazole. The findings of this study were published in Mycoses Journal.

Onychomycosis is a fungal infection of the nail that causes subungual hyperkeratosis, discoloration, and onycholysis. Dermatophytes, yeasts (Candida), and non-dermatophyte moulds are among the pathogens involved. It is a difficult therapeutic challenge. The total cure rate with itraconazole pulse therapy remains unsatisfactory, indicating the need for a more effective treatment regimen. Given the success of itraconazole and isotretinoin in the treatment of recurrent dermatophytosis, the therapeutic use of acitretin in onychomycosis was investigated in this study, it also assessed and compared the efficacy of combined itraconazole and acitretin therapy versus monotherapy with each in the treatment of onychomycosis.

This study included 135 adult patients with onychomycosis of the finger and/or toe nails. They were divided into three groups based on their effectiveness: itraconazole pulse therapy, acitretin, and combined itraconazole/acitretin therapy. The drugs were given for three months. The severity of onychomycosis was determined using the onychomycosis severity index score. At the beginning and end of the study, potassium hydroxide microscopy and culture were performed.

The results of this study stated as follow:

1. Onychomycosis was completely cured in 51.1% and 20% of the itraconazole groups, 28.9% and 28.9% of the acitretin groups, and 80% and 53.3% of the combined group, respectively.

2. The combined itraconazole/acitretin therapy had a statistically significant advantage over the other groups (P.05).

The major limitations of this study were the very few sample size and a short duration of the project.

In conclusion, this study found that combining acitretin and pulsed itraconazole is superior to pulsed itraconazole alone in onychomycosis treatment.

references:

Nasr M, Abd-Elhamid N, Abd-Allah D, Elkholy B. Acitretin: Could it be a new therapeutic player in the field of onychomycosis? Mycoses. 2022 Feb 1. doi:10.1111/myc.13424. Epub ahead of print. PMID: 35103343.

Keywords: dermatophytosis, Mycoses, Onychomycosis, fungal infection, Acitretin, itraconazole, antifungals, hyperkeratosis,