A meta-analysis of the six trials of nail infections available in 2009 concluded that they provided evidence that topical ciclopirox had poor cure rates, and that amorolfine might be substantially more effective, but more research was required.

These outcomes followed long treatment times (48 weeks) and this makes ciclopiroxolamine a poor choice for nail infections.

"[7] Efinaconazole, an azole antifungal, led to cure rates two or three times better than the next-best topical treatment, ciclopirox.

[9] However, loss of function of certain catalase and peroxidase enzymes has been implicated as the mechanism of action, as well as various other components of cellular metabolism.

Initial results showed similar efficacy to ketoconazole with a relative increase in subjective symptom relief due to its inherent anti-inflammatory properties.