What is the best oral treatment for those nasty looking toes?

COCHRANE REVIEW: Kreijkamp-Kaspers S, Hawke K, Guo L, Kerin G, Bell-Syer SEM, Magin P, Bell-Syer SV, van Driel ML. Oral antifungal medication for toenail onychomycosis. Cochrane Database of Systematic Reviews 2017, Issue 7.

THE PROBLEM: Onychomycosis is a fungal infection of the nail. It is a common condition that accounts for 50% of all nail diseases. It has a worldwide prevalence of 2–8%.¹ Onychomycosis is more likely to affect older adults, people with diabetes, people with psoriasis and people who are immunosuppressed.¹ Griseofulvin was the first oral antifungal agent used to treat this condition² with the azole group of medications coming next, followed by terbinafine.²

CLINICAL BOTTOM LINE: This Cochrane review showed that terbinafine was the most effective treatment for achieving a normal looking nail. Azole was also an effective treatment as was griseofulvin. Griseofulvin however, was more likely to cause greater incidence of adverse effects and was not as effective as terbinafine or azole.³