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Therapy: Onychomycosis Initial therapy In cases of distal involvement (without matrix involvement): topical nail lacquer can be used (e.g. ciclopirox nail lacquer, amorolfine lacquer [not available in all countries]). Because of the possible toxicity from long-term therapy with systemic antifungal antibiotics, it is necessary to obtain a positive KOH preparation, culture prior to initiating therapy. […]