What is distal subungual onychomycosis tx?

• 1st line treatment • Terbinafine 250 mg daily for 12 weeks – Risks: idiosyncratic hepatotoxicity, reversible taste disturbance, drug interactions (P450 CYP2D6 inhibitor), skin reactions Must prevent patients on risks and monitor liver function tests (LFT’s) – Do not begin treatment without confirmation of fungus on culture, KOH, or histologic exam • Clinical cure only seen in 50% of patients, so treatment failure is a significant risk • 2nd line therapies Itraconazole, Fluconazole • These may be helpful in lesions caused by nondermatophyte molds or yeast • Obtain positive fungal culture to identify organism before initiating second-line therapies