Treatment plan
Treatment plan
Conservative measures:
• Nail cutting
• Avoid running in tight footwear
• Treat associated tinea pedis
Topical antifungals:
• Amorolfine nail lacquer (for superficial, early, limited infection or candida)
Oral antifungals:
• Terbinafine (for dermatophyte infections)
o Fingernails: 6 – 12 weeks
o Toenails: 12 – 24 weeks
• Itraconazole or fluconazole (for non-dermatophyte or candida infections)
Follow-up:
• Reassess nail regrowth in 3-6 months
• If treatment failure: repeat sampling/clipping, consider a combination of topical and
oral antifungals
Referral:
• Podiatry if nail trauma from footwear or discomfort from thickened nails
• Consider oral antifungals for children if primary care measures fail