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Research Letter
November 29, 2017

Laboratory Monitoring During Systemic Terbinafine Therapy for Pediatric Onychomycosis

Author Affiliations
  • 1University of Louisville, School of Medicine, Louisville, Kentucky
  • 2Department of Pediatrics, Section of Dermatology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 3Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 4Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
JAMA Dermatol. Published online November 29, 2017. doi:10.1001/jamadermatol.2017.4483

Onychomycosis is a fungal infection of the nail resulting in discoloration, thickening, and separation from the nail bed. Pediatric onychomycosis has a reported incidence of 0.4% to 2.6%.1 Topical antifungal therapy has been shown to have some efficacy in children compared with adults; however, when the infection involves the nail matrix, systemic therapy is often indicated.2 Terbinafine is the systemic antifungal of choice, with cure rates as high as 80%.3 Though terbinafine is well tolerated, hepatotoxic effects have been reported in adults.4 There are fewer risk factors for liver injury in children and consensus regarding laboratory surveillance during therapy has not been reached, with physician preference varying widely. The aim of our study was to investigate the prevalence of laboratory monitoring and laboratory abnormalities during systemic terbinafine therapy in pediatric patients with onychomycosis.

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