Dermatology3.docx

Running head: TOENAIL ONYCHOMYCOSIS 1

TOENAIL ONYCHOMYCOSIS 3

Toenail Onychomycosis
Orquidea Ruiz
Florida National University

Oral therapies for treatment of onychomycosis are preferred as compared to topical therapies. The two drugs of choice for onychomycosis are terbinafine and itraconazole. The drugs are to be administered orally for 12 weeks for the treatment of toenail onychomycosis (Gupta et al., 2019). In the case of the patient described in this study, the following is the prescription that should be given:
Terbinafine, 250 mg, OD X 12 weeks.
Itraconazole, 200 mg, OD X 12 weeks.
Terbinafine is considered as the safest drug for diabetic patients (Gupta et al., 2019). Pulse treatment with both drugs is also recommended pulse terbinafine treatment consists of 250 mg terbinafine taken once daily for four weeks, off for four weeks then back on for four weeks. When it comes to itraconazole, three pulses are recommended for toenail onychomycosis with each pulse consisting of 200 mg itraconazole taken twice daily for 1 week then off for three weeks (Gupta et al., 2019).
Before starting treatment with either terbinafine or itraconazole, liver function tests (LFTs), complete blood counts (CBCs) should be carried out to form a baseline. These tests should be done every three weeks for monitoring during the course of the treatment and also at the end of the treatment. Since these drugs are associated with hepatotoxicity, treatment should be discontinued if the LFTs indicate values two or three times higher than the normal or if clinical examination warrants stopping (Gupta et al., 2019).

References
Gupta, A. K., Mays, R. R., Versteeg, S. G., Piraccini, B. M., Takwale, A., Shemer, A., Babaev, M., Grover, C., Di Chiacchio, N. G., Taborda, P. R. O., Taborda, V. B. A., Shear, N. H., Piguet, V., & Tosti, A. (2019). Global perspectives for the management of onychomycosis. International Journal of Dermatology, 58(10), 1118–1129. https://doi.org/10.1111/ijd.14346