Which of the following comorbid conditions is a relative contraindication for the use of oral agents for treating onychomycosis of the toenails? (AIIMS Nov 2012)
|A||Chronic kidney disease|
|D||Poorly controlled diabetes mellitus|
1). Oral antifungal agents are required for effective treatment of dermaphytosis of the hair or nails.
2). Treatment requires prolonged courses of drug (e.g., 2–18 months) and exposes the patient to an increased risk of adverse reaction to the drug. All of the oral agents carry a risk of hepatotoxicity.
3). They should not be used in women who are pregnant or breast-feeding.
4). Griseofulvin is approved for dermatophyte infections of the skin, hair, or nails. Itraconazole and terbinafine are approved for onychomycosis.
5). With terbinafine therapy, there is also a risk of drug-drug interaction with drugs that require the P450 enzyme for metabolism.
6). Most treatment courses require serial monitoring of liver enzymes to avoid drug-induced hepatitis or liver failure.