Med. Mycol. J.

Med.
Vol. 64, Mycol. J. Vol. 64 (No. 2) , 2023
45-47, 2023 45
ISSN 2185-6486

Short Report

A Case of Nail Yellow Discoloration due to Topical Treatment of

Onychomycosis with Luliconazole 5% Nail Solution
1 1 1 1 2
Tomotaka Sato , Norihito Fukada , Akihiko Kinjo , Ryuta Akimoto , Hisashi Kobayashi ,
2
and Satoshi Fukuzumi
1
Department of Dermatology, Teikyo University Chiba Medical Center
2
Department of Plastic and Reconstructive Surgery, Teikyo University Chiba Medical Center

ABSTRACT
A woman in her 70s had onychomycosis that was treated with topical luliconazole solution. Her nails changed color to yellow
due to the treatment and exposure to sunlight. Avoidance of sunlight and continuous application of luliconazole resolved the
discoloration and were effective for the treatment of onychomycosis one year after the first visit.
Key words : luliconazole 5% nail solution, nail discoloration, onychomycosis, photodegradation, yellow

4, 5)
tion . All discolored nail plates were opened by a
Introduction dermatologist using a nipper. We treated her with topical
luliconazole cream on the toes and soles of the foot and 5%
Onychomycosis is a fungal infection of the nail plate that luliconazole solution on the nail. As the patient walked outside
1, 2)
may also cause secondary infections . Daily observation of wearing sandals without socks during treatment, she noticed
the toenails, care of the foot, and treatment of onychomycosis her nail change its color to yellow (Fig. 2a). We advised the
are important to prevent discomfort during walking, diabetic patient about sunlight protection, and to not walk outside
toe gangrene, and secondary bacterial infection. without socks. A report from the drug manufacturer suggested
Although oral treatment is the first choice, some patients are that the change in nail color to a yellowish color was caused by
6)
unable to use oral drugs. For such patients, efinaconazole 10% photodegradation of luliconazole . After one year from the
topical solution or luliconazole 5% nail solution is adminis- first visit, the fungal infection of the big toe was resolved by
3)
tered for topical treatment of onychomycosis in Japan . topical treatment (Fig. 2b), and the nail discoloration was also
Dermatophytoma is a type of onychomycosis for which nail resolved. Avoidance of exposure to sunlight of the treated nail
debridement with oral or topical treatment is carried out. should be recommended during topical treatment of lulicona-
Herein, we report a case of onychomycosis treated with nail zole 5% nail solution.
debridement and application of topical luliconazole 5% nail
solution to the nail and topical luliconazole 1% cream to the Discussion
foot.
®
Luliconazole 5% nail solution (Luconac 5% solution) has
Case report been reported in Japan as an effective compound against
onychomycosis. This drug is applied once a day for an
A woman in her seventies with chronic urticaria had nail extended period. Unfavorable outcomes include dryness of the
spike discoloration on her left big toe (Fig. 1a). We opened the skin and contact dermatitis similar to those of other topical
®
spike lesions with a plastic nipper (Fig. 1b). We diagnosed it drugs. Luconac contains N-methylpyrrolidone, benzyl alco-
as dermatophytoma by KOH direct microscopic examina- hol, adipic acid diisopropyl ester, lactic acid, polyvinylpyrroli-

Address for correspondence: Tomotaka Sato, MD, PhD

Department of Dermatology, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba 299-0111, Japan
Received: 6 December 2022, Accepted: 7 February 2023
E-mail: zxg03117@nifty.ne.jp
 46 Medical Mycology Journal Volume 64, Number 2, 2023

a b

Fig. 1. Clinical picture of onychomycosis on the left big toe.

a: Longitudinal white and yellow discoloration.
b: Nail plate opened by a dermatologist.

a b

Fig. 2. Clinical picture of discoloration of the toenail.

a: Six months after Luconac® 5% solution was applied once a day, the patient noticed
yellow discoloration of the nail during the summer.
b: One year after the first visit.

6)
done, and anhydrous ethanol without active pharmaceutical yellowish . This suggested that sunlight should be avoided
ingredients. There have been previous cases of nail discolora- during treatment.
®
tion due to topical treatment. Furthermore, since Luconac In summary, we report a case of onychomycosis treated
was sold in Japan in 2016, there have been some reports of with topical luliconazole solution that showed yellow
cases showing nail discoloration during treatment. According discoloration on the nail caused by the topical treatment and
to a report from the manufacturer, the yellow discoloration is sunlight exposure. Avoidance of sunlight and continuous
caused by photodegradation of luliconazole in both the nail application of luliconazole resolved the yellow discoloration
surface and nail plate, and of the nail surface and onychomycosis.
6)
polyvinylpyrrolidone .
Hasuko et al. reported that a white discoloration was Conflicts of interest
observed on nails after repeated topical application of
luliconazole 5% nail solution and that maintaining the nail in Tomotaka Sato received research funds and a grant from
an artificial environment illuminated with white fluorescent Sato Pharmaceutical Co. Ltd., Sun Pharma Co. Ltd., and Eisai
light at 10000 lux caused the white discoloration to turn Co. Ltd.
 Med. Mycol. J. Vol. 64 (No. 2) , 2023 47

management of dermatomycosis (2019). J Dermatol 47: 1343-

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