Onychomycosis, a fungal infection of the nail, is surprisingly common, accounting for somewhere between 15% and 40% of all nail diseases. To effectively treat onychomycosis, the antifungal medication needs to get into the nail itself, and that’s not always easy to accomplish.
One option is ciclopirox 8% nail lacquer, a topical treatment that’s applied directly to the nail. Ciclopirox is formulated with hydroxypropyl chitosan (HPCH), which is thought to improve how well the drug soaks into the nail.
So, does ciclopirox penetrate the nail? That’s what we’ll explore here, along with how well it works and what factors might affect the success of the treatment. Topical treatments are especially important when oral medications aren’t a good option, whether because they’re contraindicated for a particular person or because the person has trouble sticking to the oral treatment plan.
Oral antifungal therapies have a failure rate of 25% to 40%, so it’s important to have other options available, like Clarus AC Antifungal.
Understanding onychomycosis and nail structure
Before we talk about whether ciclopirox penetrates the nail, let’s get some background.
What is onychomycosis?
Onychomycosis is a fungal infection in your nail. It’s usually caused by dermatophytes, yeasts, and non-dermatophyte molds.
Dermatophytes are the most common cause, but non-dermatophyte molds are increasingly recognized as a culprit. They are responsible for about 20% of cases in North America and 5% of cases in the UK.
If you have onychomycosis, your nails may be thickened, discolored, brittle, or distorted. They can also cause pain and discomfort.
Nail anatomy and physiology
To really understand how medications work, it’s helpful to know how nails are structured.
- Nail plate: This is the hard, translucent part of the nail made of keratin. It’s dense, so it can be difficult for medications to pass through.
- Nail bed: The nail bed is the skin underneath the nail plate. Fungi thrive in this area.
- Nail matrix: This is the area where the nail plate forms. If the matrix is damaged, it can cause permanent nail deformities.
Ciclopirox 8% Nail Lacquer: Formulation and how it works
Ciclopirox nail lacquer 8% is a topical antifungal medication often prescribed for onychomycosis, or fungal nail infections.
What’s in ciclopirox nail lacquer?
- Ciclopirox. This is the active ingredient, a man-made antifungal that stops fungus from growing by interfering with its cell membrane functions.
- Hydroxypropyl chitosan (HPCH). HPCH is what specialists call the “vehicle.” It’s a film-forming polymer with glue-like properties that helps the medication stick to the nail and get through the nail plate.
How does it work?
Ciclopirox works in a couple of ways to treat fungal nail infections:
- Antifungal action. Ciclopirox snatches up certain charged atoms (like iron and aluminum), which throws off the way fungal enzymes work.
- Enhanced penetration. The HPCH in the medication makes it easier for the ciclopirox to get through the nail plate and stay at therapeutic levels for up to 30 hours.
- Film formation. The lacquer makes a film over the surface of the nail, which allows the drug to release slowly over time.
Does ciclopirox penetrate the nail?
One of the most important questions about ciclopirox is whether it can actually get into the nail to do its job.
In vitro studies
Scientists have performed studies in the lab to learn more about how ciclopirox works.
- Permeation studies: These studies show that ciclopirox can diffuse through the nail plate in a lab setting. Researchers have found that ciclopirox in an 8% concentration penetrates nails better when it’s formulated with HPCH (hydroxypropyl chitosan) than when it’s in other kinds of lacquer.
- Drug concentration analysis: These studies measure how much ciclopirox reaches different layers of the nail.
In vivo studies
Scientists have also conducted studies with real patients to learn more about ciclopirox.
- Clinical trials: These trials look at how well ciclopirox nail lacquer treats onychomycosis (nail fungus) in people who have it. Researchers have found that how long it takes to cure a nail depends on how fast the patient’s nails grow and how old they are.
- Drug distribution studies: These studies assess how ciclopirox spreads out inside the nail tissue after someone puts it on their nail.
Factors that affect penetration
Some factors can affect how well ciclopirox penetrates the nail:
- Nail thickness: If the nail is thick, it may take longer for the medication to work.
- Nail hydration: Hydrated nails are more permeable, which means the medication can get through more easily.
- Application technique: To ensure you’re getting enough medication to the nail, apply it to the affected nail and the skin around it, about 5mm out from the nail.
How well does ciclopirox work?
When doctors talk about whether an antifungal medication like ciclopirox works, they often look at two things: the mycological cure rate and the clinical cure rate.
Mycological cure rates
The mycological cure rate is the percentage of people who have negative fungal cultures after treatment. In other words, after using the medication, a lab test shows that the fungus is gone. Sometimes, that can happen pretty quickly, within a couple of months.
But how well ciclopirox works depends on a few things, such as:
- how closely you follow the treatment instructions
- what kind of fungus is causing the infection
- how bad the infection is to begin with
Clinical cure rates
The clinical cure rate is the percentage of people whose nails look completely normal again after treatment. Because nails grow slowly, it can take a long time to get rid of a nail infection completely. Onychomycosis treatment often takes 36-48 weeks to get rid of the infection entirely.
Why following directions matters
To get the best results from ciclopirox, it’s really important to use it exactly as your doctor tells you. This means understanding how to put it on your nails, knowing how long you need to keep using it, and applying the lacquer as directed. This means:
- understanding how to put it on your nails
- knowing how long you need to keep using it
- applying the lacquer as directed, typically once daily at bedtime
- removing loose nail or debris and re-applying medication, as prescribed
If you have any questions about how to use ciclopirox, be sure to ask your doctor or pharmacist.
Special considerations: Diabetic patients and non-dermatophyte infections
Not all nail infections are the same, and some populations need special care when it comes to onychomycosis treatment.
Onychomycosis in diabetic patients
About a third of people with diabetes may have onychomycosis. Because diabetes can cause so many other health issues, treatment can be tricky. Diabetics often face treatment challenges due to comorbidity.
Topical treatments like ciclopirox are a safer choice than oral medications for people with diabetes. The ease of application and effectiveness of topical treatments is a real benefit. It’s one less systemic medication to worry about.
Non-dermatophyte mold infections
Not all nail infections are caused by dermatophytes. A significant number of onychomycosis cases are caused by nondermatophyte molds, which are often challenging to treat. Nondermatophyte molds are responsible for a significant portion of onychomycosis cases, often challenging to treat.
Ciclopirox offers some hope for treating these infections, as it has shown activity against some non-dermatophyte molds.
How to use ciclopirox, precautions, and potential side effects
How to apply ciclopirox
Here’s how to use ciclopirox topical solution to treat nail fungus:
- Before you apply, get rid of any loose nail material.
- Apply the medication as directed, usually once a day before you go to bed. Be sure to cover the entire affected nail and the skin around it (about 5 mm, or 1/4 inch).
- Let the medication dry fully before you put on socks or stockings.
- Don’t wash the area for at least 8 hours after you apply the medication.
- Follow your doctor’s instructions about when to remove the medication and reapply it.
Precautions
Before using ciclopirox, be sure to let your doctor and pharmacist know about any medical conditions you have and any allergies you’re aware of.
Tell your doctor about any medications you’re taking, including over-the-counter medicines and supplements, especially before you have surgery.
If you’re pregnant or breastfeeding, talk with your doctor about whether ciclopirox is right for you.
Side effects
Ciclopirox can cause side effects.
Common side effects include:
- redness
- burning
- changes in the shape or color of your nails
More serious side effects are rare, but if you experience blistering, swelling, or oozing, contact your doctor right away.
Serious allergic reactions (rash, itching, swelling) are also rare, but if you have any symptoms of an allergic reaction, get medical help right away.
Frequently Asked Questions
What is the success rate of ciclopirox topical solution?
Ciclopirox topical solution has a relatively low success rate compared to oral medications for toenail fungus. Studies suggest a complete cure rate of around 5.5% to 8.5% after 48 weeks of treatment. It’s often most effective for mild to moderate infections, particularly when combined with good nail care.
What is the strongest toenail fungus treatment?
Oral antifungal medications, such as terbinafine and itraconazole, are generally considered the strongest and most effective toenail fungus treatments. They have higher cure rates than topical options like ciclopirox because they work systemically to eliminate the fungus.
How to know if toenail fungus is dying?
Signs that toenail fungus is dying include new, healthy nail growth at the base of the nail, a decrease in nail thickness, and a reduction in discoloration or crumbling. It can take several months to see noticeable improvement, as the affected nail needs to grow out completely.
How to remove ciclopirox from nails?
Ciclopirox nail lacquer is designed to be removed with alcohol. You should use an alcohol swab to clean the nails once a week to remove the build-up of the lacquer before re-applying. Follow the specific instructions provided by your doctor or pharmacist.
Should you scrape out toenail fungus?
It’s generally not recommended to scrape out toenail fungus yourself. This can damage the nail bed and increase the risk of infection. A podiatrist can safely debride (thin and remove) the affected nail tissue to improve the penetration of topical medications and promote healing.
The Bottom Line
Ciclopirox 8% nail lacquer, especially the kind made with HPCH, works by penetrating the nail plate. Lab tests and real-world studies show that it can get enough of the drug into the nail to fight the fungal infection underneath.
To get the best results, you have to use the medication exactly as directed and apply it correctly. It’s also important to consider things like how bad the infection is and whether you have any other health problems that could affect how well the medicine works. Sticking to the treatment plan is key to getting rid of the infection.
Ciclopirox is still a good option for treating nail fungus, especially for people who can’t take oral medications. Before using it, consider real user reviews and results. The newer lacquers, with their improved penetration and longer-lasting effects, may lead to better success rates than older treatments.