title: Treatment options--development of consensus guidelines.
abstract: BACKGROUND
  There are currently three main treatment strategies for onychomycosis: topical, oral and combination. Amorolfine nail lacquer appears to be the most effective form of topical monotherapy. However, the best mycological and clinical cure rates are obtained with combination therapy. Combination therapy increases antifungal spectrum, fungicidal activity and safety. New antifungals (triazoles and echinocandins) were recently developed, enabling new protocols.
  
  
  OBJECTIVE
  To review available therapies. To design an algorithm for the management of onychomycoses in daily practice.
  
  
  RESULTS
  Therapeutic choice should be based on numerous factors including patient's age and health, aetiology, extent of involvement and clinical form. The consensus was that topical monotherapy is recommended when < 50% of the nail is affected without matrix area involvement. Oral monotherapy or combination therapy is indicated when > 50% of the nail, including the matrix area, is involved. Topical treatments should not be used alone when topical drug transport is suboptimal (i.e. when dermatophytoma, onycholysis or spikes are present). Chemical or mechanical removal should also be considered whenever applicable (interruption of drug transport).
  
  
  CONCLUSIONS
  In conclusion, treatment decision-making tools (e.g. an illustrated booklet or CD-ROM presenting each type of onychomycosis and criteria to be considered before selecting treatment regimen) would be valuable supports for the successful treatment of onychomycoses.
authors.affiliation: Servicio de Dermatologia, Hospital Clinic I Provincial de Barcelona, Villarroel, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Lecha
authors.forename: I
authors.initials: I
authors.lastname: Effendy
authors.forename: M
authors.initials: M
authors.lastname: Feuilhade de Chauvin
authors.forename: N
authors.initials: N
authors.lastname: Di Chiacchio
authors.forename: R
authors.initials: R
authors.lastname: Baran
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000935:Antifungal Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009262:Nails / Q000601:surgery*; D014009:Onychomycosis / Q000175:diagnosis / Q000628:therapy*; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D014005:Tinea / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome; D014249:Trichophyton / Q000302:isolation & purification*
chemical_list: D000935:Antifungal Agents