The systemic treatment of onychomycosis.

The systemic treatment of fungal infections has changed considerably over the past 10 to 20 years. Though griseofulvin was introduced in the late 1950s and was at the time the only Food and Drug Administration (FDA)-approved drug in the United States for the systemic treatment of onychomycosis, its cure rate seldom exceeds 40%. Newer drugs appear to be reducing treatment times, improving cure rates with a minimum of side effects, and achieving long-term remissions in recalcitrant infections. Itraconazole was FDA approved in 1995, and terbinafine was FDA approved in 1996. Both have been used safely for many years, demonstrating efficacy in short-term treatment with a low incidence of side effects. Fluconazole, though not yet FDA approved for onychomycosis, has also shown efficacy in many situations. Direct-to-the-public advertising has raised interest in patients to seek treatment. There are also some new investigational drugs for fungal infections that may augment or supplant current therapy.