Treating onychomycosis

Onychomycosis accounts for one third of fungal skin infections, Because onl y about one half of nail dystrophies are caused by fungus, the diagnosis sh ould be confirmed by potassium hydroxide preparation, culture or histology before treatment is started. Newer, more effective antifungal agents have m ade treating onychomycosis easier. Terbinafine and itraconazole are the the rapeutic agents of choice. Although the U.S. Food and Drug Administration h as not labeled fluconazole for the treatment of onychomycosis, early effica cy data are promising. Continuous oral terbinafine therapy is most effectiv e against dermatophytes, which are responsible for the majority of onychomy cosis cases. Intermittent pulse dosing with itraconazole is as safe and eff ective as short-term continuous therapy but more economical and convenient. With careful monitoring, patients treated with the newer antifungal agents have a good chance of achieving relief from onychomycosis and its complica tions.