Clinical use of the topical nail liquid efinaconazole in 484 patients with onychomycosis including long-term cases.

For the treatment of onychomycosis, only oral drugs and topical medications not specifically indicated for this disease were available until a specific topical drug was released. In September 2014, a topical drug for onychomycosis was first marketed in Japan (efinaconazole: Clenafin Ⓡ ), and clinical results concerning its use for one year or longer have not yet been reported. We investigated 484 patients who were prescribed efinaconazole for treatment of onychomycosis at our department. Among the patients in whom cure was achieved, treatment for one year or longer was required in more than 30%, and the overall cure rate was 14.9% in the actual clinical setting. Among all patients, 81.3% showed improvement to some extent (including cure). With regard to safety, there were no systemic adverse reactions, while contact dermatitis was observed in 13 out of 484 patients. The launch of efinaconazole, which causes fewer adverse reactions, has provided an option for patients who would not show an adequate response to conventional treatments. In particular, this drug can be a first-line treatment for elderly patients and those using multiple oral medications. However, good patient adherence is crucial for a successful outcome, as well as assiduous management by the physician at the time of treatment initiation. A detailed explanation about the realistic prospect of cure should also be provided.