Treatment of special populations
In pediatric patients, efinaconazole should be given as firstline monotherapy. If oral treatment is needed, use terbinafine. Additionally, other family members should be checked for onychomycosis or tinea pedis and treated as needed, as a child with infection is often indicative of other family members with infection. Patients aged ≥65 years or patients with diabetes, peripheral vascular disease, or compromised immune systems should be treated with a combination of a topical and either terbinafine or fluconazole. For patients taking concomitant medications, a topical with or without terbinafine or fluconazole is recommended dependent on disease severity, though drug-drug interactions must be checked. Patients with liver or kidney disease should be given a topical as first-line treatment; fluconazole can be used second-line with caution.38 Patients with concurrent nail psoriasis should first be treated for onychomycosis by severity as noted above. In patients with dermatophytomas (defined in Figure 2), efinaconazole is the preferred treatment.24 The authors make no recommendations on medications for pregnant or lactating patients as there are insufficient data on their safety.
Combination medications
There was a consensus that, while more research is needed, combination treatment using two drugs with differing mechanisms of action is a possible strategy to minimize antifungal
