What my father avoided taking was terbinafine, an oral therapy to treat onychomycosis that the US Food and Drug Administration (FDA) had approved just months before the barricade mishap. Terbinafine is now the gold standard of treatment and is available as a cheap and relatively effective generic. But the drug can cause serious side effects, including liver damage. That makes antifungal pills inappropriate for some people—for example, individuals who have liver disease—and unattractive to others, like my dad. According to Warren Joseph, a podiatrist at Roxborough Memorial Hospital in Philadelphia who specializes in infectious diseases, the risk of severe side effects is slight. But “it's been blown up on the internet,” he says. “A lot of people don't want to take pills for something they view as a cosmetic problem.”
Consequently, many companies are working to develop even safer treatments that can be applied topically. In late May, the FDA rejected one of the most promising candidates, a liquid medicine called efinaconazole, over concerns about the closure apparatus used in the product's container. The drug's developer, the Canadian firm Valeant Pharmaceuticals, expects to resolve those issues and gain market approval soon. “As no efficacy or safety issues were raised by the FDA, Valeant believes that these items can be addressed and is working for a timely response to the FDA as soon as possible,” the company stated in a 28 May press release.
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