[The management of onychomycosis]

Despite the appearance of the new systemic drugs there is still an incompressible failure rate in treating patients affected by onychomycosis. Moreover some patients are unable or unwilling to take oral drugs. They perceive the infection to be too trivial to deserve systemic therapy. In addition the use of the new potent systemic drugs may sometimes be limited by adverse effects and drug-drug interactions. A rationale for a stepped therapeutic approach to the treatment of onychomycosis is suggested using the transungual antifungal delivery systems, the systemic antifungal drugs and surgical or chemical debridement. Long-term management with the nail lacquers applied twice a month should still improve the cure rate and its economic implication.