title: Oral therapy for onychomycosis: an evidence-based review.
abstract: BACKGROUND
  Onychomycosis is a very common fungal infection of the nail apparatus; however, it is very hard to treat, even when the causative agent is identified, and usually requires prolonged systemic antifungal therapy. Until the 1990s, oral treatment options included only griseofulvin and ketoconazole, and the cure rate was very low. New generations of antimycotics, such as fluconazole, itraconazole and terbinafine have improved treatment success.
  
  
  METHODS
  Literature was identified by performing a PubMed Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL, and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) search. Prospective and randomized clinical trials were chosen to be included in this review. Forty-six trials were included.
  
  
  RESULTS
  Fluconazole, itraconazole and terbinafine are effective in the treatment of onychomycosis and have a good safety profile. When a dermatophyte is the pathogen, terbinafine produces the best results. For Candida and nondermatophyte infections, the azoles, mainly itraconazole, are the recommended therapy.
  
  
  CONCLUSIONS
  In the majority of the studies, terbinafine treatment showed a higher cure ratio than the other drugs for dermatophyte onychomycosis.
authors.affiliation: Department of Dermatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil, sa-coelho@ig.com.br.
authors.forename: Daniel Coelho
authors.initials: DC
authors.lastname: de Sá
authors.forename: Ana Paula Botto
authors.initials: AP
authors.lastname: Lamas
authors.forename: Antonella
authors.initials: A
authors.lastname: Tosti
mesh_terms: D000284:Administration, Oral; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D015725:Fluconazole / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage / Q000627:therapeutic use; D009281:Naphthalenes / Q000008:administration & dosage / Q000627:therapeutic use; D014009:Onychomycosis / Q000188:drug therapy*; D000077291:Terbinafine
chemical_list: D000935:Antifungal Agents; D009281:Naphthalenes; D017964:Itraconazole; D015725:Fluconazole; D000077291:Terbinafine