For centuries, scientists have tried their best in discovering and developing the best treatment for onychomycosis, but there are too many challenges and obstacles. They have developed various treatments for this disease, such as griseofulvin which has been available for a long time but can only serve in a very narrow spectrum, ketoconazole (Nizoral) which found to be effective but also can increase the hepatotoxicity risk.

Since onychomycosis is a fungal disease, most types of treatments aimed for this disease are based on topical antifungal prevention. However, in most cases, the patient feels uncomfortable while using this treatment. Later, the scientists also found that nail avulsion treatment combined with topical antifungal therapy can become more successful in treating the patient, but it takes more time than the conventional treatment and painful in some cases which becomes the reason for so many people to refuse to undergo this treatment.

In the last few years, the medical world finally reached critical development in treatinng onychomycosis. Scientists finally discovered a more effective way in fighting the disease using oral antifungal medication which works as specific treatment that consider the patient’s nail profiles, characteristics, infecting organism, drug interactions, and other treatments. All these factors are very important because they can affect the treatment itself.

Using the observation results based on above parameters, scientists finally discover that triazole and allylamine can replace griseofulvin and ketoconazole as medications for onychomycosis. Both medications can provide higher cure rates than the old ones, as well as terbinafine and itraconazole which has become so popular in public because of their effectiveness in curing onychomycosis, especially in treating both the nail and its bed.

Another common medication used for onychomycosis treatment is terbinafine. It is an allylamine-based antifungal medication which can fight the dermatophytes, the major cause of onychomycosis. Later, it was reported that this medication is not suitable to fight certain types of non-dermatophytes, especially from candida species. It was also reported that they have headache, rash, and gastrointestinal upset after using this medication for their onychomycosis treatment. Further researches also discovered other complications brought by this medication, including but not limited to cholestatic hepatitis and Steven-Johnson syndrome.

In order to prevent further medical complication caused by this medication, doctors are strongly suggested to take test on patient’s liver enzyme levels and blood before applying this medication for the treatment. In most cases, it is also very important to repeat the use of this medication every six weeks during the treatment, however this medication should immediately be stopped if there is a valid proof that shows the patient’s aspartate aminotransferase or alanine aminotransferase level is increasing up to 200%.  For patient’s safety purpose, FDA finally announced that the safe dosage for terbinafine is 250 mg per day which is given continuously for 12 weeks during the treatment to cure onychomycosis infection. Using this dosage, various researches discovered that patient will be able to reach mycologic cure rate up to 82% while at the same time their clinical cure rate will reach 70%.

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