A person's foot with a fungal nail infection ten weeks into a course of terbinafine oral medication. Note the band of healthy (pink) nail growth behind the remaining infected nails. Medications Most treatments are with antifungal medications either topically or by mouth. Avoiding use of antifungal therapy by mouth (e.g. terbinafine) in persons without a confirmed infection is recommended because of the possible side effects of that treatment. Medications that may be taken by mouth include terbinafine (76% effective), itraconazole (60% effective) and fluconazole (48% effective). They share characteristics that enhance their effectiveness: prompt penetration of the nail and nail bed, and persistence in the nail for months after discontinuation of therapy. Ketoconazole by mouth is not recommended due to side effects. Oral terbinafine is better tolerated than itraconazole. For superficial white<unk> , systemic rather than topical antifungal therapy is advised. Topical agents include ciclopirox nail paint, amorolfine, and efinaconazole. Some topical treatments need to be applied daily for prolonged periods (at least 1 year). Topical amorolfine is applied weekly. Topical ciclopirox results in a cure in 6% to 9% of cases; amorolfine might be more effective. Ciclopirox when used with terbinafine appears to be better than either agent alone. In trials, about 17% of people were cured using efinaconazole as opposed to 4% of people using placebo. Although eficonazole, P-3051 (ciclopirox 8% hydrolacquer), and tavaborole are effective at treating fungal infection of toenails, complete cure rates are low. Other Chemical (keratolytic) or surgical debridement of the affected nail appears to improve outcomes. As of 2014 evidence for laser treatment is unclear as the evidence is of low quality and varies by type of laser. Tea tree oil is not recommended as a treatment, since it is not effective and can irritate the surrounding skin. Cost United States According to a 2015 study, the cost in the United States of testing with the periodic acid–Schiff stain (PAS) was about $148. Even if the cheaper KOH test is used first and the PAS test is used only if the KOH test is negative, there is a good chance that the PAS will be done (because of either a true or a false negative with the KOH test). But the terbinafine treatment costs only $10 (plus an additional $43 for liver function tests). In conclusion the authors say that terbinafine has a relatively benign adverse effect profile, with liver damage very rare, so it makes more sense cost-wise for the dermatologist to prescribe the treatment without doing the PAS test. (Another option would be to prescribe the treatment only if the potassium hydroxide test is positive, but it gives a false negative in about 20% of cases of fungal infection.) On the other hand, as of 2015 the price of topical (non-oral) treatment with efinaconazole was $2307 per nail, so testing is recommended before prescribing it.
Onychomycosis
Psoriasis
Otomycosis
Dermatitis
Tinea versicolor
Paronychia
Lentigo simplex
Psoriatic onychodystrophy