dermatologic disorders
Onychomycosis
Treatment
Selective use of oralterbinafineoritraconazole Occasional use of topical treatments (eg,efinaconazole,tavaborole,ciclopirox8%, amorolfine) Onychomycosis is not always treated because many cases are asymptomatic or mild and unlikely to cause complications, and the oral drugs that are the most effective treatments can potentially cause hepatotoxicity and serious drug interactions. Some proposed indications for treatment include the following: Previous ipsilateral Cellulitis None Diabetes Mellitus (DM) or other risk factors for cellulitis Presence of bothersome symptoms Psychosocial impact Desire for cosmetic improvement (controversial) Treatment of onychomycosis is typically oralterbinafineoritraconazole.Terbinafine250 mg once a day for 12 weeks (6 weeks for fingernail) or pulse therapy with 250 mg once a day for 1 week a month until the nail is clear achieves a cure rate of 75 to 80% anditraconazole200 mg 2 times a day 1 week a month for 3 months achieves a cure rate of 40 to 50%, but the overall recurrence rate is estimated to be as high as 10 to 50%. It is not entirely necessary to treat until all abnormal nail is gone because these drugs remain bound to the nail plate and continue to be effective after oral administration has ceased; however, risk of recurrence may be higher in such cases. The affected nail will not revert to normal, but newly growing nail will appear normal.Fluconazolemay also be an option. The newer topical agentsefinaconazoleandtavaborolecan penetrate the nail plate and are more effective than older topical agents. Investigative treatments include new delivery systems forterbinafine. Topical antifungal nail lacquer containingefinaconazole10%,ciclopirox8%, or amorolfine 5% (not available in the US) is occasionally effective as primary treatment (cure rate of about 30%) and can improve cure rate when used as an adjunct with oral drugs, particularly in resistant infections. To limit relapse, the patient should trim nails short, dry feet after bathing, wear absorbent socks, and use antifungal foot powder. Old shoes may harbor a high density of spores and, if possible, should not be worn. 