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
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