My patient’s onychomycosis is responding poorly despite treatment with terbinafine (Lamisil) and itraconazole (Sporanox). What do you suggest I do next?—GARY S. EDWARDS, DO, Ft. Smith, Ark.

Some cases of onychomycosis are recalcitrant to treatment, including those of extensive and/or lateral nail involvement. In these cases, an extra month of oral medication may be beneficial. If this is not successful, nail debridement or avulsion may be a helpful addition.—Jeffrey M. Weinberg, MD (146-9)