Hepatic Transaminases Evaluation in Patients with Onychomycosis Treated with Oral Antifungals: A Retrospective Study with 229 Patients

<p>Introduction: Onychomycosis is the most common nail disorder in dermatology. Treatment can be challenging due to factors related to the pathogen and the patient’s health status. Therapeutic options include topical and oral antifungals; while oral agents offer higher cure rates, they also present drawbacks such as prolonged treatment duration and potential adverse effects, with liver toxicity being the most frequently reported. Previous reviews highlight a scarcity of studies addressing the actual frequency of liver enzyme alterations during therapy. Methods: This retrospective study analyzed medical records from 313 patients treated at the Dermatology Clinic of a tertiary hospital. Changes in hepatic transaminases (aspartate aminotransferase, aspartate aminotransferase/TGO, and alanine aminotransferase, alanine aminotransferase/TGP) were evaluated in patients with a confirmed diagnosis of onychomycosis undergoing treatment with systemic antifungals. Results: Among 229 patients, 22 (9.6%) exhibited elevated hepatic transaminase levels. Oral antifungals demonstrated an overall favorable safety profile, with a low rate of transaminase elevation and no cases of hepatotoxicity. Patients with multiple comorbidities and concomitant medication use were more likely to present laboratory abnormalities, suggesting a possible cumulative effect on hepatic metabolism. Conclusion: In a real-world tertiary hospital setting, where most patients carried multiple comorbidities and were on continuous medications, oral antifungals for onychomycosis demonstrated a reassuring hepatic safety profile. The low incidence of enzyme alterations, all reversible after drug withdrawal, supports the continued use of systemic therapy in appropriately selected patients, reinforcing that comorbidities alone should not preclude oral antifungal treatment when clinically indicated. </p>