[Why should we treat onychomycosis with patience and perseverance? How can we overcome therapeutic failure?]

Antifungal treatments for onychomycoses may be long and expensive without, however, affording the guarantee of success. A review of the literature reveals that the current topical treatments and the oral intake of fluconazole are of long duration. They show moderate clinical efficacy and/or a pharmaco-economic profile less favorable than those of intermittent itraconazole therapy and terbinafine continuous therapy. Between the latter two options, itraconazole has some advantages because of its broad spectrum of activity against diverse types of fungi responsible for onychomycoses. The fungicidal activity of terbinafine exhibited in vitro cannot unfortunately be claimed in the in vivo situation when treating a patient. Some interactions exist between these antifungals and a few other drugs. Other side effects are rare and usually discrete and reversible.