Onychomycosis: The Daily PANCE Blueprint

The answer is B. Terbinafine

Onychomycosis is a nail fungal infection (more common in toenails). It occurs in about 2-10% of the general population. The most common cause is dermatophytes (e.g., Trichophyton rubrum). Risk factors include older age, cancer or immunodeficiency, smoking, nail trauma, or occlusive footwear. On physical exam, you will see a thickened nail with white, yellow, or brown discoloration. The diagnosis may need to be confirmed by KOH preparation, culture, or histology. In general, the first line (most effective) treatment option is oral terbinafine. A systematic review and meta-analysis found evidence for the superiority of terbinafine over the azoles in reaching a cure/treatment. However, caution must be taken because there are many drug-drug interactions and adverse effects.