TRADITIONAL MANAGEMENT OF ONYCHOMYCOSIS

The traditional management of onychomycosis includes mechanical, chemi cal, and surgical approaches, as well as topical and oral antifungal m edications. Topical preparations have been consistently disappointing, and the tendency in later years has been to rely on two systemic agen ts-griseofulvin and ketoconazole-for management of more severe or reca lcitrant infections. However, both drugs require a long duration of th erapy (4 to 6 months for fingernails, 10 to 18 months for toenails). E ven with such prolonged treatment, the overall success rate is only ab out 15% to 30% for toenail infections and 50% to 70% for fingernail in fections. Furthermore, both griseofulvin and ketoconazole have numerou s potential side effects and drug/drug interactions. Therefore, labora tory monitoring should be performed during the course of treatment wit h these agents and they should be used only after evaluation of the pa tient's current medical status and a review of concomitant medications .