Dermatophyte (Fungal) Infection - Nail

Take nail clippings: start therapy only if infection is confirmed by laboratory.

Oral terbinafine is more effective than oral azole.

Idiosycratic liver reactions occur rarely with oral antifungals.

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

For children, seek specialist advice.

First line: terbinafine

250mg once daily

fingers: 6-12 weeks

toes: 3-6 months

Second line: itraconazole

200mg once daily

For 3 months

 

OR itraconazole

200mg twice daily

fingers: for 7 days then repeat after 21 days for 2 cycles

toes: for 7 days then repeat after 21 days for 3 cycles

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

1 or 2x/week

fingers: 6 months

toes: 12  months