What it is

➝ Ciclopirox nail lacquer (usually 8%) is a topical antifungal treatment used for mild to moderate onychomycosis (fungal nail infection).

➝ Unlike systemic antifungals, ciclopirox works locally, penetrating the nail plate to kill fungi and prevent further growth.

➝ It is most effective in cases where the nail matrix (growth area) is not heavily involved and the infection affects less than 50% of the nail surface.

➝ In Korea, ciclopirox lacquer is often used as a first-line therapy for early infections or as adjunct therapy alongside oral antifungals or laser treatments.

Why it’s done

→ To treat fungal nail infections without systemic medication, avoiding risks to the liver and systemic side effects.

→ To manage patients who cannot take oral antifungals due to health conditions or drug interactions.

→ To provide maintenance therapy after systemic antifungals or laser treatment, reducing recurrence.

→ To improve nail appearance and hygiene over time.

→ In Korea, ciclopirox lacquer is widely prescribed in dermatology and podiatry clinics, often as part of a comprehensive onychomycosis program.

Alternatives

→ Other topical antifungals:

• Efinaconazole solution (often considered more effective but costlier).
• Amorolfine lacquer (not available everywhere).

→ Systemic antifungals: Terbinafine, itraconazole, fluconazole (more effective for moderate-to-severe infections).

→ Laser therapy: Nd:YAG or diode laser to improve drug penetration and fungal clearance.

→ Mechanical/chemical nail debridement: Filing, trimming, or urea-based keratolytics to thin the nail.

Preparation

→ Nails should be cleaned, trimmed, and filed down to reduce thickness before applying ciclopirox.

→ Patients are advised to avoid nail polish or cosmetic lacquers, as these block penetration.

→ Disinfection of nail tools, socks, and shoes is recommended to prevent reinfection.

→ In Korea, clinics often perform professional nail debridement/scaling before starting lacquer therapy, improving penetration and outcomes.

How it’s Done

→ Daily application: Ciclopirox is applied once daily to the entire affected nail, extending slightly to surrounding skin.

→ Weekly removal:

• Once a week, the lacquer is removed with alcohol or nail polish remover.
• The infected nail surface is filed down before reapplying fresh lacquer.

→ Duration:

• Fingernails: ~6 months.
• Toenails: ~9–12 months (due to slower growth).

→ Patients must be consistent and patient, as visible results take time while the healthy nail grows out.

→ In Korea, dermatologists often recommend combining ciclopirox lacquer with antifungal shampoo/foot care for best results.

Recovery

→ Early improvements in nail appearance may be seen in 2–3 months, but full clearance usually takes 6–12 months.

→ The nail gradually becomes clearer as new growth pushes out the infected part.

→ Patients experience better cosmetic results, improved comfort, and reduced embarrassment.

→ Long-term success depends on consistent use and proper foot/nail hygiene.

Complications

→ Local irritation: Redness, burning, or itching around the nail fold (rare).

→ Ineffectiveness in advanced disease: If more than 50% of the nail is affected or the nail matrix is involved, ciclopirox alone is unlikely to cure.

→ Reinfection risk: Without hygiene and preventive care, fungi can return even after successful treatment.

Treatment Options in Korea

→ Korean dermatology clinics frequently use ciclopirox nail lacquer as part of a stepwise treatment plan.

→ It is often combined with:

• Laser treatments to enhance penetration.
• Oral antifungals in moderate-to-severe infections (dual therapy).
• Professional nail debridement for better drug absorption.

→ Clinics emphasize patient education on:

• Proper daily application.
• Weekly removal and nail filing.
• Shoe/sock hygiene to prevent reinfection.

→ Many Korean clinics also provide photographic monitoring, showing patients nail progress over time to encourage adherence.

→ Overall, ciclopirox lacquer is valued in Korea as a safe, convenient, and effective treatment for mild cases and as maintenance or adjunct therapy in more severe infections.