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Oral Therapy for Onychomycosis: An Evidence-Based Review

  • Evidence-Based Review
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Abstract

Introduction

Onychomycosis is a very common fungal infection of the nail apparatus; however, it is very hard to treat, even when the causative agent is identified, and usually requires prolonged systemic antifungal therapy. Until the 1990s, oral treatment options included only griseofulvin and ketoconazole, and the cure rate was very low. New generations of antimycotics, such as fluconazole, itraconazole and terbinafine have improved treatment success.

Methods

Literature was identified by performing a PubMed Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL, and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) search. Prospective and randomized clinical trials were chosen to be included in this review. Forty-six trials were included.

Results

Fluconazole, itraconazole and terbinafine are effective in the treatment of onychomycosis and have a good safety profile. When a dermatophyte is the pathogen, terbinafine produces the best results. For Candida and nondermatophyte infections, the azoles, mainly itraconazole, are the recommended therapy.

Conclusion

In the majority of the studies, terbinafine treatment showed a higher cure ratio than the other drugs for dermatophyte onychomycosis.

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No sources of funding were used to prepare this article. The authors have no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Department of Dermatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil

    Daniel Coelho de Sá

  2. Aracaju, SE, Brazil

    Ana Paula Botto Lamas

  3. Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA

    Antonella Tosti

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  1. Daniel Coelho de Sá
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Correspondence to Antonella Tosti.

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de Sá, D.C., Lamas, A.P.B. & Tosti, A. Oral Therapy for Onychomycosis: An Evidence-Based Review. Am J Clin Dermatol 15, 17–36 (2014). https://doi.org/10.1007/s40257-013-0056-2

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