Oral terbinafine, itraconazole, and griseofulvin and topical ciclopirox 8% nail lacquer, efinaconazole 10% solution, and tavaborole 5% solution are approved by the Food and Drug Administration for treatment of onychomycosis in the United States and amorolfine 5% nail lacquer is approved in Europe. Oral antifungals are generally recommended for moderate to severe onychomycosis and have higher cure rates, while topical antifungals are recommended for mild to moderate disease and have more favorable safety profiles. There are several different therapeutic options available, including oral and topical medications as well as device-based treatments. Confirmatory testing should be performed for each patient prior to initiating any antifungal therapies. Several approaches are available for definitive diagnostic testing, including potassium hydroxide and microscopy, fungal culture, histopathology, polymerase chain reaction, or a combination of techniques. A thorough history and physical examination, including dermoscopy, should be performed for each patient presenting with nail findings suggestive of onychomycosis. 1Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA 2Weill Cornell Medicine, Department of Dermatology, New York, NY, USAĬorrespondence: Shari R Lipner, Weill Cornell Medicine, Department of Dermatology, 1305 York Avenue, NY, NY, 10021, USA, Tel +1 64, Fax +1 64, Email Ībstract: Onychomycosis is the most common nail disease encountered in clinical practice and can cause pain, difficulty with ambulation, and psycho-social problems.
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