Sprucing up treatment for fungal nail infection

By Helen Albert, Senior medwireNews Reporter

A lacquer containing resin from the Norway spruce (Picea abies) shows promise as a treatment for onychomycosis, suggest results from an exploratory study.

These findings support those of previous research showing that spruce resin is an effective antifungal and antimicrobial agent in vitro.

Treatment of onychomycosis can be a challenge, as oral medications such as terbinafine, while relatively effective, can be expensive and have a high side-effect risk, and the most effective conventional topical treatments such as amorolfine and cicloprirox only have a 30% cure rate. In addition, both treatment types can be very long in duration.

Janne Jokinen (Helsinki University Hospital, Finland) and colleagues tested the efficacy of topically applied P. abies lacquer for treatment of fungal nail infection in 37 patients with the condition.

The lacquer was applied daily for 9 months. The researchers took nail samples at the beginning and end of the treatment period to test for the presence of dermatophytes (potassium hydroxide stain) and a positive mycologic culture.

At baseline, 15 patients were culture or dermatophyte positive and 22 had negative results on both tests. Four weeks after treatment was completed, nine patients who were initially positive had negative findings on both tests, compared with 17 in the initially negative group.

Overall, 14 patients who completed the study period considered the treatment to be clinically effective, with partial healing seen in 11 cases and total healing in three.

The treatment was not completely effective, as five initially positive patients had positive dermatophyte and/or mycologic culture tests at study completion, as did two patients in the initially negative group.

Overall, four patients (one initially positive; three initially negative) dropped out of the study, but in general compliance was good.

Jokinen and team acknowledge that their study was small and observational in nature, but they say "the present trial indicates some preliminary, positive clinical efficacy in usage of natural resin as topical treatment of onychomycosis."

However, "randomized and controlled clinical trials are needed to corroborate this claim and to provide details on which subjects benefit the most from this form of treatment of onychomycosis," they conclude.

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