Dermatophyte Infection - Nail

Dermatophyte infection - nail

CKS

Oral terbinafine is more effective than oral azole.

Liver reactions rare with oral antifungals.

Send nail clippings if treatment failure.

If candida or non-dermatophyte infection confirmed, use oral itraconazole.

Stop treatment when continual, new, healthy, proximal nail growth.

 

For children, seek specialist advice.

To prevent recurrence: apply weekly 1% topical antifungal cream to entire toe area.

 

First line: terbinafine

250mg OD 

fingers: 6-12 weeks

toes: 3-6 months

Second line: itraconazole

200mg BD

7 days monthly

fingers: 2 courses

toes: 3 courses

Third line for very superficial as limited evidence of effectiveness: amorolfine 5% nail lacquer

1-2x/weekly

fingers: 6 months

toes: 12  months