Treatment of onychomycosis: traditional approaches

Fungal infections account for approximately 20% of all nail diseases, and the incidence of onychomycosis is increasing. Traditional therapies are often ineffective. The activity, clinical efficacy, pharmacokinetics, and patient acceptability of griseofulvin and ketoconazole, the two "traditional" oral agents, are reviewed and compared with two new agents, terbinafine and itraconazole. Both griseofulvin and ketoconazole are effective in dermatophyte infections but require long-term therapy. Ketoconazole, although also active against Candida species, is restricted in use by a rare incidence of hepatotoxicity. Terbinafine and itraconazole diffuse more rapidly into the stratum corneum and nail and are more effective with short-term treatment.