What should patients expect when undergoing treatment of onychomycosis?

The cure rate is 60% to 80% (not 100%). Fingernails grow 3 mm per month with complete replacement in about 6 months. Toenails grow 1 mm per month with replacement in 12 to 18 months. Therefore, at the end of a 6- to 12-week treatment course, the nails will not appear completely normal, but there usually is some healthy nail proximally. Of additional reassurance to patients is the fact that terbinafine and itraconazole reach maximum concentrations in the nail plate after discontinuing the medication, and they are present in the nail up to 9 months after treatment. There is a high risk of recurrence for toenail involvement, which can be mitigated by daily topical antifungal powders, creams, lacquers, and sprays.

Wolverton S: Comprehensive dermatologic drug therapy, Philadelphia, 2001, WB Saunders.