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More proximal or extensive disease

Authoring team

  • for more proximal or extensive onychomycosis topical treatments are unlikely to be effective and systemic treatment should be considered

  • the systemic treatment of choice is Terbinafine 250mg daily. This should be continued for between 6 weeks and 3 months in fingernail infection, or for 3 to 6 months in toenail onychomycosis (1). Further cultures might be taken at 3 months to assess the necessity for prolonged treatment. In cases of toenail dystrophy a nail paint may also be added in. The success of treatment is of cure in 80-95% of cases. Terbinafine interacts with relatively few other drugs and is generally well tolerated

  • alternative systemic treatments for dermatophyte onychomycosis include
    • Itraconazole as pulsed therapy - 200mg twice daily for 1 week a month for 2 months in fingernail and for 3 months in toenail infections
    • Griseofulvin 10mg/kg/daily for 6-9 months in fingernail infection or 15-18 months for toenails (no longer considered as a treatment option for dermatophyte infections)

 

Reference:


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