Alternatives to oral antifungals

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What do you suggest for an onychomycosis patient who cannot tolerate oral antifungals?—JESSE M. HALL, MPAS, PA-C, Sanford, N.C.

Topical antifungal agents, although usually not curative for onychomycosis when used as monotherapy, may be partially effective in improving or preventing further progression of tinea unguium, particularly in a patient with dermatophyte infection of the nails who is unable to tolerate oral antimycotic drugs. Several formulations of topical antifungal agents are available: lacquers, solutions, creams, and gels. Lacquers and solutions may be more suitable for fungal disease involving only the nail plate, whereas creams or gels may be more practical when the tinea infection involves the toes and feet as well as the nails.—Philip R. Cohen, MD (143-9)

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