After diagnosing onychomycosis, what should a physician ensure before starting treatment?

Before starting treatment for onychomycosis, it is important for a physician to ensure that liver function tests are conducted. This is particularly relevant because the most commonly used systemic antifungal medications for treating onychomycosis, such as terbinane and itraconazole, can have hepatotoxic effects. Assessing liver function before initiating treatment helps to identify any pre-existing liver conditions that could increase the risk of serious side effects from these medications.

Liver function tests measure enzymes that indicate the condition of the liver. Abnormal results may prompt the physician to consider alternative treatments, such as topical antifungal agents, or to monitor liver function closely during treatment. This consideration is critical for patient safety, especially in those with risk factors for liver disease or those who may be taking other medications that also stress the liver.

While other tests, such as kidney function tests and a full blood count, may be important in different clinical scenarios or for monitoring side effects of certain medications, they are not as directly related to the risks associated with the typical treatments for onychomycosis. An electrolyte panel might be useful in different contexts but is also not relevant to the initial assessment for onychomycosis treatment.