title: Toenail Onychomycosis-A Canadian Approach With a New Transungual Treatment: Development of a Clinical Pathway.
abstract: BACKGROUND
  Onychomycosis is a difficult-to-treat infection whose current treatment paradigm relies primarily on oral antifungals. The emergence of new topical drugs broadens the therapeutic options and prompts a re-evaluation of the current Canadian treatment strategy.
  
  
  OBJECTIVE
  To define a patient-centred Canadian treatment strategy for onychomycosis.
  
  
  METHODS
  An expert panel of doctors who treat onychomycosis was convened. A systematic review of the literature on treatments for onychomycosis was conducted. Based on the results, a survey was designed to determine a consensus treatment system.
  
  
  RESULTS
  First-line therapy should be selected based on nail plate involvement, with terbinafine for severe onychomycosis (>60% involvement), terbinafine or efinaconazole for moderate onychomycosis (20%-60% involvement), and efinaconazole for mild onychomycosis (<20% involvement). Comorbidities, patient preference and adherence, or nail thickness may result in the use of alternative oral or topical antifungals.
  
  
  CONCLUSIONS
  These guidelines allow healthcare providers and patients to make informed choices about preventing and treating onychomycosis.
authors: University of Toronto, Toronto, ON, Canada, & Mediprobe Research Inc, London, ON, Canada agupta@execulink.com.
authors: Aditya K
authors: AK
authors: Gupta
authors: University of Toronto, Mississauga, ON, Canada.
authors: R Gary
authors: RG
authors: Sibbald
authors: Malden and UMC St Radboud Nijmegen, The Netherlands.
authors: Anneke
authors: A
authors: Andriessen
authors: Département de Médecine Familiale et, Médecine d'urgence, Faculté de Médecine de l'Université Laval, Québec, QC, Canada.
authors: Richard
authors: R
authors: Belley
authors: Vancouver General Hospital, Vancouver, BC, Canada.
authors: Alan
authors: A
authors: Boroditsky
authors: Women's College Hospital, Toronto, ON, Canada.
authors: Mariam
authors: M
authors: Botros
authors: FAAFAS, Toronto, ON, Canada.
authors: Robert
authors: R
authors: Chelin
authors: Faculty of Medicine, Memorial University, St John, NF, Canada.
authors: Wayne
authors: W
authors: Gulliver
authors: General Practitioner, London, ON, Canada.
authors: David
authors: D
authors: Keast
authors: FRCPC, Toronto, ON, Canada.
authors: Mani
authors: M
authors: Raman
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D002170:Canada; D032921:Consensus; D019091:Critical Pathways; D006801:Humans; D009262:Nails / Q000382:microbiology; D014009:Onychomycosis / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D014034:Toes / Q000382:microbiology
chemical_list: D000935:Antifungal Agents
keywords: clinical pathway; toenail onychomycosis; transungual treatment