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Onychomycosis is a fungal infection of the toenails and fingernails that results in thickening, discoloration, splitting as well as lifting of the nails from the nail bed. It affects 14% of the total world population, with more prevalence in elders and diabetics. Both dermatophytes (Trichophyton rubrum or T. mentagrophytes) and nondermatophytes (Scopulariopsis brevicaulis, Aspergillus spp, Fusarium spp, and sometimes Candida spp) have been identified as etiologic agents of onychomycosis. The treatment of onychomycosis is known to be challenging since it is a chronic condition, difficult to eradicate and tends to relapse [1]. The pharmacotherapy of onychomycosis involves prolonged systemic or oral antifungal therapy due to slow overturn rate of nail as well as limited blood circulation into the affected nail bed. However, complete cure that involves a clinical cure (normal nail morphology) and mycological cure (both negative microscopy and dermatophyte culture), is often unattainable. In recent years the development of antifungal drugs of second generation (fluconazole, itraconazole, and terbinafine) has produced notable, long-term cure rates with shorter treatment period and improved safety profiles as compared to the first generation antifungal agents. However, different dosage regimens of various antifungal agents have been used by various researchers in clinical trials in order to ensure the complete eradication of the fungal infection in a shorter period with better efficacy.

Is This the Right Drug or the Dose for the Management of Onychomycosis?