Hepatic transaminases evaluation in patients with onychomycosis treated with oral antifungals: a retrospective study with 229 patients

Introduction: Onychomycosis is the most common nail disorder in dermatology. Treatment can be challenging due to factors related to the pathogen and the patient’s health status. Therapeutic options includetopical and oral antifungals; while oral agents offer higher cure rates, they alsopresent drawbacks such as prolonged treatment duration and potentialadverse effects, with liver toxicitybeing the mostfrequently reported. Previous reviewshighlight a scarcity of studies addressing theactual frequency of liver enzyme alterations duringtherapy. Methods: This retrospective study analyzed medical records from313 patientstreated at theDermatology Clinic of a tertiary hospital. Changes in hepatic transaminases were evaluated inpatients with a confirmed diagnosis of onychomycosisundergoing treatment withsystemic antifungals. Results: Among229 patients, 22(9.6%) exhibited elevatedhepatic transaminase levels. Oral antifungals demonstrated anoverall favorable safety profile, with alow rate oftransaminase elevation andno cases of hepatotoxicity. Patients with multiple comorbidities and concomitant medication use were more likely to presentlaboratory abnormalities, suggesting a possible cumulative effect on hepatic metabolism. Conclusion:In a real-world tertiaryhospital setting, wheremost patients carriedmultiple comorbidities and wereon continuousmedications, oral antifungals for onychomycosis demonstrated a reassuring hepatic safetyprofile. The low incidence of enzymealterations, all reversible after drugwithdrawal, supports the continued use ofsystemic therapy in appropriately selected patients, reinforcingthat comorbidities aloneshould not preclude oral antifungal treatmentwhen clinically indicated.