Treatment of dermatophyte onychomycosis

Consider treatments for:

• distal and localised nail disease
  
  
• more proximal or extensive onychomycosis

Treat only if infection confirmed by laboratory

• only use topical treatment if superficial infection of the top surface of nail plate For infections with dermatophytes use oral terbinafine or itraconazole
• for infections with candida or non-dermatophyte moulds use oral itraconazole
• idiosyncratic liver and other severe reactions occur very rarely with terbinafine and itraconazole
• for children seek expert advice

Treatments available (1,2)

• 5% amorolfine nail lacquer
  • 1-2x/weekly
    • fingers for 6 months
    • toes for 12 months
• terbinafine
  • 250 mg OD
    • fingers for 6-12 weeks
    • toes for 3-6 months
• itraconazole
  • 200 mg BD
    • fingers for 2 courses of 7 days/month
    • toes for 3 courses of 7 days/month

Reference:

• (1) Health Protection Agency 2011. Fungal nail & skin infections: diagnosis & laboratory investigation – Quick reference guide for primary care
• (2) Public Health England 2017. Fungal skin and nail infections: Diagnosis and laboratory investigation - Quick reference guide for primary care.