Which treatment is important to consider for a patient with onychomycosis who has a history of cellulitis or is diabetic?

In the context of treating onychomycosis, especially in patients with a history of cellulitis or diabetes, oral antifungal medications such as terbinafine or itraconazole are critical. These systemic treatments are more effective than topical options, particularly for individuals at higher risk for complications due to their underlying health conditions.

Patients with diabetes and a history of cellulitis can develop severe foot infections; thus, it is essential to address the fungal infection aggressively. Oral antifungal therapy targets the infection more effectively compared to topical treatments, which may not penetrate deeply enough into the nail bed and surrounding tissues to clear the infection in more challenging cases.

The recommended duration of therapy, often around three months, is based on the slow growth of nails and the time required for new, healthy nail growth to replace the infected one. This comprehensive approach is crucial for preventing possible complications such as recurrent cellulitis or persistent fungal infections, which can have significant health implications for patients with diabetes or a history of skin infections.

Other options such as immediate nail removal, while sometimes useful in severe instances, may not be necessary for all cases of onychomycosis, especially when effective systemic treatments are available. Reassurance with follow-up may not be adequate as it does