Fungal nail and skin infections
Nail - First line
Terbinafine 250mg once daily
fingers: 6 to 12 weeks
toes: 3 to 6 months
Nail - Second line
Itraconazole 200mg twice daily
7 days monthly
fingers: 2 courses
toes: 3 courses
Nail - Third line for very superficial as limited evidence of effectiveness
Amorolfine 5% nail lacquer Once or twice weekly
fingers: 6 months
toes: 12 months
Yeast infection of fingernails
Pulsed itraconazole monthly is recommended for infections with yeasts and non-dermatophyte moulds.
Oral itraconazole 200mg twice daily
7 day course, repeat after one month
Topical terbinafine 1% Cream. Apply twice daily
OR Clotrimazole 1% cream. Apply twice daily
1 to 2 weeks after healing (i.e. 4 to 6 weeks)
Information on the diagnosis and laboratory investigation of fungal nail infections can be found on the Public Health England website.
Take nail clippings: start therapy only if infection is confirmed by laboratory.
Oral terbinafine is more effective than oral azole.
Liver reactions rare with oral antifungals.
If candida or non-dermatophyte infection confirmed, use oral itraconazole.
For children, seek specialist advice.
Terbinafine is fungicidal: treatment time shorter than with fungistatic imidazoles.
If candida possible, use imidazole.
If intractable, send skin scrapings, and if infection confirmed, use oral terbinafine/itraconazole.
Scalp: discuss with dermatology, oral therapy indicated