Fungal nail infection, scientifically, it is known as Onychomycosis. It is characterized by discoloration, detachment, and thickening of nails. If left uncared, it can become brittle with an irregular surface. In simple, it is defined as dystrophy of toenails and fingernails which cause embarrassment and discomfort to affected individuals. Onychomycosis always associated with nail psoriasis can cause psychosocial problems. This problem is not as dangerous as such, but it does not resolve without treatment, can be transmitted from nail to nail and even between individuals. Nail trauma will also increase the risk of fungal infection of the affected nail, especially in the geriatric population (1).
Does Kerasal Cure Nail Fungus?
Yes, the proportion of solution containing propylene glycol, urea, and lactic acid cured patients and improved their Nail Fungus conditions. With statistically significant differences versus placebo treatment from 2 weeks until the end of the study at 26 weeks (5). After 4 weeks of treatment, discoloration, thickening, and softness each showed improvements in patients. Skin irritation and other adverse effects were moderate and clinician unable to decide to be related to K101-03 in that study. To successfully cure toenail onychomycosis requires long treatment duration that may extend to a full year. Even then, complete cure, defined as clinical cure (implying nail clearing) plus mycological cure (both negative microscopy and dermatophyte culture), is often unattainable (7).
What Is Kerasal?
Kerasal is a marketed topical treatment containing propylene glycol, urea and lactic acid (2). It is well known as K101 or Kerasal Nail™ (K101-05) in the market (3). It has shown good efficacy and tolerability in clinical investigations. A study says that K101-03 produced rapid improvements in the patients (92.2%) after continuous 8 weeks of treatment in their target nail (4). There was evidence available that K101-03 was well tolerated in patients with onychomycosis or nail psoriasis and rapidly improved their nails.
However, treatment-related adverse events (side effects) were observed in some patients in onychomycosis patients treated with Kerasal Nail. K101-03 is a marketed Ethylenediaminetetraacetic acid (chelating agent) containing derivate of K101 in which some of the propylene glycols has been replaced with glycerol to increase viscosity and thus make application easier.
Fungal Profile
Onychomycosis is an infection of the nail apparatus by dermatophytes, yeasts, or molds. Increased prevalence in recent years is attributed to enhanced longevity, comorbid conditions such as diabetes, avid sports participation, and the emergence of HIV. Dermatophytes are the most commonly implicated etiologic agents, particularly Trichophyton rubrum and Trichophyton mentagrophytes var. interdigitale, followed by Candida species (C. parapsilosis, C. guilliermondii. C. albicans) and non dermatophytic molds (Fusarium Sp, Scopulariopsis brevicaulis, Aspergillus fumigatus, Acremonium spp., Chrysosporium pannorum, Neoscytalidium dimidiatum , Arthrographis kalrae, Chaetomium globosum as well as T. interdigitale, and Chaetomium globosum) (6,9).
Risk Factors for Toenail Onychomycosis
Nail symptoms arise in 10–60% of patients undergoing anticancer treatment. Immunosuppressants agents can damage the nail plate. The most common malignancies affecting the nails are squamous cell carcinoma and Bowen’s disease (8). The most prevalent predisposing risk factor for developing onychomycosis is advanced age. Men are up to three times more likely to have onychomycosis than women. These infections can be transmitted within the family, e.g., in the home bathtub, either horizontally (from one spouse to the other) or vertically (across generations).
Conclusion
Kerasal is a marketed topical treatment containing propylene glycol, urea, and lactic acid. 8 weeks of treatment of Kerasal in nail fungus patients have shown much improvement in their target nail. Improvements start from 4 weeks of treatment. There was no treatment-related adverse effect in many studies. They are effective, well tolerated, and patient-friendly. K101-03 (Kerasol TM) rapidly improves the nails of patients with onychomycosis and/or nail psoriasis. Thus, it helps to alleviate embarrassment and stigmatization in patients with these conditions.
- Onychomycosis in clinical practice: factors contributing to recurrence. Scher RK, Baran R Br J Dermatol. 2003 Sep; 149 Suppl 65():5-9.
- Faergemann, J. and Swanbeck, G. (1989) Treatment of Onychomycosis with a Propylene Glycol-Urea-Lactic Acid Solution. Mycoses, 32, 536-540.
- Pan JY, Tan CL, Toft A. Rapid visible improvements in onychomycosis: an open-label clinical investigation of Kerasal Nail™ J Cosmet Dermatol Sci Appl. 2017;7:57–66.
- Piraccini BM, Starace M, Toft A. Early Visible Improvements during K101-03 Treatment: An Open-Label Multicenter Clinical Investigation in Patients with Onychomycosis and/or Nail Psoriasis. Dermatology. 2017;233(2-3):178–183.
- Treatment of distal subungual onychomycosis with a topical preparation of urea, propylene glycol and lactic acid: results of a 24-week, double-blind, placebo-controlled study. Emtestam L, Kaaman T, Rensfeldt K Mycoses. 2012 Nov; 55(6):532-40.
- Indian J Dermatol Venereol Leprol. 2011 Nov-Dec;77(6):659-72. doi: 10.4103/0378-6323.86475. Onychomycosis: Diagnosis and management.
- Ghannoum M, Isham N. Fungal nail infections (onychomycosis): a never-ending story?. PLoS Pathog. 2014;10(6):e1004105. Published 2014 Jun 5. doi:10.1371/journal.ppat.1004105
- Bowen’s disease of the nail apparatus: a series of 8 patients and a literature review. Wollina U Wien Med Wochenschr. 2015 Oct; 165(19-20):401-5.
- Systematic review of nondermatophyte mold onychomycosis: diagnosis, clinical types, epidemiology, and treatment. Gupta AK, Drummond-Main C, Cooper EA, Brintnell W, Piraccini BM, Tosti A J Am Acad Dermatol. 2012 Mar; 66(3):494-502
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