|Commercial products to treat onychomycosis include griseoflulvin,
itraconazole, terbinafine and circlopirox 8% nail lacquer.
Griseofulvin has reported poor cure rates and requires
10 – 18 months of use. Oral therapy with itraconazole
and terbinafine also present problems with drug interactions
and liver toxicity. A patient with compromised liver function
or a GERD patient on a PPI may not be a candidate for
oral antifungals. For patients who cannot use antifungals,
ciclopirox lacquer is the only commercial topical treatment
available, however, it reportedly has only a 14% cure
rate after several months of use. Having a compounded
prescription medication may overcome these problems and
avoid the need for extensive liver monitoring. We can
dissolve an antifungal in a penetrating base with dimethylsulfoxide
(DMSO) that has superior nail penetration and it is able
to deliver an antifungal to the site of infection. Examples
of antifungals that can be compounded in DMSO are azole
antifungals and terbinafine.
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