Fungal nail and skin infections

CKS - nail
CKS - skin
CKS - foot
CKS - scalp

Nail

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.

Skin

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

Drug details

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

Skin

Topical terbinafine 1% Cream. Apply twice daily

7 days

Skin

OR Clotrimazole 1% cream. Apply twice daily

1 to 2 weeks after healing (i.e. 4 to 6 weeks)

Last reviewed: 23 May 2019

Next review: 30 May 2022

Author(s): Antimicrobial Management Team

Approved By: TAM Subgroup of ADTC

Reviewer Name(s): Area Antimicrobial Pharmacist

Document Id: AMT165