Therapeutic strategies in onychomycosis

Objective: This paper reviews current advantages and limits of modern topical antifungal agents (amorolfine, ciclopirox nail lacquer, bifonazole/urea ointment) and oral antimycotic drugs (itraconazole, terbinafine) in the treatment of onychomycosis, taking into account the results of clinical trials. Results: Clinical studies show that both topical and oral antimycotic therapy are effective in treating onychomycosis. However, topical antimycotic treatment produces high efficacy only in superficial and minor distal subungual onychomycosis. The newer oral antifungal drugs have been relatively well tolerated so far. Nevertheless, if oral antimycotic treatment schedules of several months are used, liver function should be monitored. Conclusion: Knowledge of the advantages and limits of both topical and systemic antimycotic treatment of onychomycosis is a prerequisite for a reasonable and effective therapy. Consequently, a therapeutic strategy in onychomycosis is useful to aid physicians choose a suitable treatment.