Swipe om te navigeren naar een ander artikel
The online version of this article (https://doi.org/10.1186/s13047-019-0332-3) contains supplementary material, which is available to authorized users.
Onychomycosis, a fungal infection affecting the nail plate, is a common condition often requiring prolonged treatment regimens, with low success rates. Urea is one treatment option, which is thought to improve the efficacy of topical and oral antifungal agents. Despite a theoretical basis for the use of urea for the treatment of onychomycosis, the evidence-base for this treatment has not been systematically reviewed.
The purpose of this study was to conduct a systematic literature review to determine the efficacy and safety of urea as a monotherapy and as adjunct therapy, compared to other treatment regimens for onychomycosis.
A systematic literature search of ten electronic databases was conducted. Only studies that used microscopy and culture or other validated laboratory-based testing method to confirm the presence of a fungal infection before treatment were included. The outcome measures assessed were efficacy (defined in terms of mycological, clinical and complete cure) and safety (defined as self-reported adverse events).
The systematic search yielded 560 unique studies for review. Of these, only six were eligible for inclusion. All studies were observed to have methodological concerns, most studies consisted of small sample sizes and were difficult to compare given heterogeneity in outcome measures and follow-up time. Despite this, a trend was observed to suggest that urea, when added to topical or oral antifungal treatment regimens, improved efficacy of the treatment.
This review suggests that topical urea, as an adjunct to topical and oral antifungal treatment regimens, may improve the efficacy of treatment. However, further research is needed.
Additional file 1: Modified McMaster tool (DOCX 17 kb)13047_2019_332_MOESM1_ESM.docx
Gupta AK, Daigle D, Paquet M. Therapies for onychomycosis: a systematic review and network meta-analysis of mycological cure. J Am Podiatr Med Assoc. 2015;105(4):357–66. CrossRef
Faergemann J, Baran R. Epidemiology, clinical presentation and diagnosis of onychomycosis. Br J Dermatol. 2003;149(s65):1–4. CrossRef
Bodman M, Feder L, Nace A. Topical treatments for onychomycosis: a historical perspective. J Am Podiatr Med Assoc. 2003;93(2):136–41. CrossRef
Akhtar N, Sharma H, Pathak K. Onychomycosis: potential of nail lacquers in transungual delivery of antifungals. Scientifica. 2016;2016:1387936. CrossRef
Matricciani L, Talbot K, Jones S. Safety and efficacy of tinea pedis and onychomycosis treatment in people with diabetes: a systematic review. J Foot Ankle Res. 2011;4(1):26. CrossRef
Gupta AK, Versteeg SG, Shear NH. Onychomycosis in the 21st century: an update on diagnosis, epidemiology, and treatment. J Cutan Med Surg. 2017;21(6):525–39. CrossRef
Saner MV, Kulkarni AD, Pardeshi CV. Insights into drug delivery across the nail plate barrier. J Drug Target. 2014;22(9):769–89. CrossRef
Nigam PK. Antifungal drugs and resistance: current concepts. Our Dermatol Online. 2015;6(2):212–21. CrossRef
Eisman S, Sinclair R. Fungal nail infection: diagnosis and management. BMJ : British Medical Journal. 2014;348. CrossRef
Crawford F, Hollis S. Topical treatments for fungal infections of the skin and nails of the foot. Cochrane Database Syst Rev. 2007;(3).
Bristow IR. The effectiveness of lasers in the treatment of onychomycosis: a systematic review. J Foot Ankle Res. 2014;7.
Wiznia LE, Quatrano NA, Mu EW, Rieder EA. A clinical review of laser and light therapy for nail psoriasis and onychomycosis. Dermatol Surg. 2017;43(2):161–72. CrossRef
Martinez-Rossi NM, Peres NT, Rossi A. Antifungal resistance mechanisms in dermatophytes. Mycopathologia. 2008;166(5–6):369. CrossRef
Kreijkamp-Kaspers, Sanne, Hawke, Kate, Guo, Linda, Kerin, George, Bell-Syer, Sally E. M., Magin, Parker, Bell-Syer, Sophie V. and van Driel, Mieke L. (2017) Oral antifungal medication for toenail onychomycosis. Cochrane Database Syst Rev, 2017 7: CD010031.
Pan M, Heinecke G, Bernardo S, Tsui C, Urea LJ. A comprehensive review of the clinical literature. Dermatol Online J. 2013;19(11).
Baran R, Coquard F. Combination of fluconazole and urea in a nail lacquer for treating onychomycosis. J Dermatol Treat. 2005;16(1):52–5. CrossRef
Bonifaz A, Ibarra G. Onychomycosis in children: treatment with bifonazole-urea. Pediatr Dermatol. 2000;17(4):310–4. CrossRef
Torres-Rodriguez JM, Madrenys N, Nicolas MC. Non-traumatic topical treatment of onychomycosis with urea associated with bifonazole. (German). Mycoses. 1991;34(11–12):499–504. PubMed
Bonifaz A, Guzman A, Garcia C, Sosa J, Saul A. Efficacy and safety of bifonazole urea in the two-phase treatment of onychomycosis. Int J Dermatol. 1995;34(7):500–3. CrossRef
Roberts DT, Hay RJ, Doherty VR, Richardson MD, Clayton YM. Topical treatment of onychomycosis using bifonazole 1% urea/40% paste. Ann N Y Acad Sci. 1988;544:586–7. CrossRef
Fritsch H, Stettendorf S, Hegemann L. Ultrastructural changes in onychomycosis during the treatment with bifonazole/urea ointment. Dermatol. 1992;185(1):32–6. CrossRef
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100. CrossRef
Council-NHaMR. NHMRC levels of evidence and grades for recommendations for guideline developers. Canberra: National Health and Medical Research Council; 2009.
Hillier S, Grimmer-Somers K, Merlin T, Middleton P, Salisbury J, Tooher R, et al. FORM: an Australian method for formulating and grading recommendations in evidence-based clinical guidelines. BMC Med Res Methodol. 2011;11(1).
Wiese C, Simpson R, Kumar S. The effectiveness of equine-based therapy in the treatment of social and Behavioural aspects of children with autism Spectrum disorder: a systematic review. Internet Journal of Allied Health Sciences and Practice. 2016;14(3).
Dars S, Uden H, Banwell HA, Kumar S. The effectiveness of non-surgical intervention (foot orthoses) for paediatric flexible pes planus: a systematic review: update. PLoS One. 2018;13(2):e0193060. CrossRef
Law M, Stewart C, Pollock N, Letts L, Bosch J, Westmorland M. McMaster critical review form - quantitative studies. Hamilton, Ontario: McMaster University occupational therapy evidence-based practice research. Group. 1998.
Law M, Stewart D, Pollock N, Letts L, Bosch J, Westmorland M. Guidelines for critical review form - quantitative studies. Hamilton, Ontario: McMaster University occupational evidence-based practice research Group; 1998.
Bassiri-Jahromi S, Ehsani AH, Mirshams-Shahshahani M, Jamshidi B. A comparative evaluation of combination therapy of fluconazole 1% and urea 40% compared with fluconazole 1% alone in a nail lacquer for treatment of onychomycosis: therapeutic trial. J Dermatol Treat. 2012;23(6):453–6. CrossRef
Lahfa M, Bulai-Livideanu C, Baran R, Ortonne JP, Richert B, Tosti A, et al. Efficacy, safety and tolerability of an optimized avulsion technique with onyster (40% urea ointment with plastic dressing) ointment compared to bifonazole-urea ointment for removal of the clinically infected nail in toenail onychomycosis: a randomized evaluator-blinded controlled study. Dermatol. 2013;226(1):5–12. CrossRef
Bunyaratavej S, Leeyaphan C, Rujitharanawong C, Surawan TM, Muanprasat C, Matthapan L. Efficacy of 5% amorolfine nail lacquer in Neoscytalidium dimidiatum onychomycosis. J Dermatol Treat. 2016;27(4):359–63. CrossRef
Fraki JE, Heikkila HT, Kero MO, Kuokkanen KE, Oksman RO, Rantanen TT, et al. An open-label, noncomparative, multicenter evaluation of fluconazole with or without urea nail pedicure for treatment of onychomycosis. Curr Ther Res Clin Exp. 1997;58(8):481–91. CrossRef
Escalante K, Martinez E, Torres-Guerrero E, Arroyo S, Arenas R. Onychomycosis with dermatophytoma. A comparison among the results of treatments with oral terbinafine, topical 40% urea in monotherapy and combination therapy. Dermat Kliniczna. 2013;15(2):67–70.
Baran R, Tosti A. Chemical avulsion with urea nail lacquer. J Dermatol Treat. 2002;13(4):161–4. CrossRef
Yaemsiri S, Hou N, Slining M, He K. Growth rate of human fingernails and toenails in healthy American young adults. J Eur Aca Dermatol Venereol. 2010;24(4):420–3. CrossRef
Yu H-J, Kwon H-M, Oh D-H, Kim J-S. Is slow nail growth a risk factor for onychomycosis? Clin Exp Dermatol. 2004;29(4):415–8. CrossRef
Scher RK, Tavakkol A, Sigurgeirsson B, Hay RJ, Joseph WS, Tosti A, et al. Onychomycosis: diagnosis and definition of cure. J Am Aca Dermatol. 2007;56(6):939–44. CrossRef
- The use of urea for the treatment of onychomycosis: a systematic review
H. A. Banwell
- BioMed Central