A 63-Year-Old Woman Reports Changes in Her Toenails

A 63-year-old woman reports changes in her toenails.  The toenails of her right foot have been discolored for 3 years and are becoming thicker and more difficult to cut.  She experiences pain in her toenails when wearing some of her high-heeled shoes.  The patient feels that her toenails are "embarrassing" when she is barefoot at the beach.
A photograph of her foot is shown below.

A KOH preparation of material removed from under the nails reveals hyphae.
What is the best therapy for this patient?

A) Daily griseofulvin
B) Daily terbinafine
C) Once-weekly fluconazole
D) Pulse itraconazole
E) Topical ciclopirox

Correct Answer:

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