What is the first line treatment for Onychomycosis (Tinea Unguium)?

The first line treatment for onychomycosis, commonly known as tinea unguium, is typically oral antifungal medications, specifically terbinafine or itraconazole. These medications are effective in treating fungal infections of the nails because they work systemically to eradicate the infection from within rather than just targeting the surface of the nail.

Oral terbinafine is particularly preferred due to its high cure rate and favorable safety profile. It works by inhibiting the synthesis of ergosterol, which is essential for fungal cell membrane integrity, ultimately leading to fungal cell death. Itraconazole is another good option that is also effective against a range of fungi. When compared to topical treatments, oral antifungals penetrate the nail matrix more effectively, allowing for a higher rate of successful treatment outcomes.

Topical clotrimazole, while useful for some superficial fungal infections, is generally not sufficient for onychomycosis because it does not penetrate the nail deeply enough to clear the infection effectively. Surgical removal of the nail can be considered in certain cases, particularly if the infection is severe or causing significant symptoms, but it is not the first line of treatment. IV amphotericin B is an antifungal used mainly for systemic fungal infections and is