FPIN's Help Desk Answers

Topical Antifungals for Treatment of Onychomycosis


Am Fam Physician. 2016 Nov 1;94(9):734.

Clinical Question

What is the rate of resolution of onychomycosis treated with topical antifungal agents?

Evidence-Based Answer

Topical antifungal agents are effective in treating onychomycosis, with a number needed to treat (NNT) of 7 to 17. (Strength of Recommendation: A, based on consistent findings from good-quality randomized controlled trials.) Efinaconazole 10% topical solution achieved complete cure rates of 15% to 18% vs. 3.3% to 5.5% for vehicle (NNT = 7 to 10). Tavaborole 5% topical solution achieved complete cure rates of 6.5% to 9.1% vs. 0.5% to 1.5% for vehicle (NNT = 13 to 17). Ciclopirox 8% nail lacquer achieved a complete cure rate of 7% compared with 1% for vehicle (NNT = 17). Each medication must be used daily for 48 weeks.

A 2013 review of two randomized, double-blind, vehicle-controlled, parallel-group, mult

Author disclosure: No relevant financial affiliations.

Address correspondence to Jose Elizondo, MD, at jose.elizondo-md@advocatehealth.com. Reprints are not available from the authors.


1. Elewski BE, et al. Efinaconazole 10% solution in the treatment of toenail onychomycosis. J Am Acad Dermatol. 2013;68(4):600–608.

2. Elewski BE, et al. Efficacy and safety of tavaborole topical solution, 5%, a novel boron-based antifungal agent, for the treatment of toenail onychomycosis. J Am Acad Dermatol. 2015;73(1):62–69.

3. Gupta AK, et al. Ciclopirox 8% nail lacquer in the treatment of onychomycosis of the toenails in the United States. J Am Podiatr Med Assoc. 2000;90(10):495–501.

Help Desk Answers provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (http://www.cebm.net/?o=1025).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to http://www.fpin.org or e-mail: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

Copyright Family Physicians Inquiries Network. Used with permission.


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