Evidence supporting the use of: Urea
For the health condition: Fungal Infections

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Synopsis

Source of validity: Scientific
Rating (out of 5): 3

Urea is used as an adjunct in the treatment of certain fungal infections, particularly dermatophytosis (such as tinea pedis and onychomycosis). Its primary mechanism is not direct antifungal activity, but rather keratolysis—the softening and breakdown of the stratum corneum (outer skin layer). This effect helps to debride thickened, hyperkeratotic skin or nails, thereby enhancing the penetration and efficacy of topical antifungal agents. Several clinical studies and reviews have documented that urea, at concentrations typically ranging from 10% to 40%, improves outcomes when combined with antifungals, especially in cases where thickening of skin or nail impedes drug delivery. For example, a 40% urea ointment is often used to soften nails prior to topical therapy for fungal nail infections.[1] However, urea alone does not possess significant antifungal properties and is not used as a monotherapy for fungal infections. The evidence for its keratolytic supportive role is moderate, with randomized controlled trials and systematic reviews supporting its adjunctive use in specific clinical contexts.[2] The overall quality of evidence is sufficient for guideline recommendations, but urea should not be considered a primary antifungal treatment.

[1] Gupta AK et al., “The use of topical agents to enhance antifungal drug penetration in onychomycosis,” J Drugs Dermatol. 2016.
[2] Lipner SR, Scher RK. “Onychomycosis: Treatment and prevention of recurrence,” J Am Acad Dermatol. 2019.

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