Management of DLSO Onychomycosis in Adults

The presentation by Dr. Alewski focuses on the diagnosis and treatment of onychomycosis in adults. Emphasizing the importance of accurate diagnosis, he cautions against assuming fungal infection based solely on nail appearance, suggesting that evidence such as a history of tinea pedis can aid in diagnosis. He details various treatment options: topical antifungals available in the US, and oral medications including terbinafine and itraconazole. Dr. Alewski reviews the dosing regimens, highlighting that terbinafine typically requires treatment for at least six months and discussing the use of itraconazole as an effective alternative, especially for cases resistant to terbinafine. He stresses the necessity for aggressive treatment to ensure complete eradication of the fungus, cautioning about potential drug interactions and side effects, particularly with itraconazole, which can cause serious issues like congestive heart failure. Dr. Alewski concludes that confirmation of fungal infection is critical before treatment initiation and that effective management should focus on completely targeting the fungus rather than adopting a minimal approach.