Dermatophyte Infection - Nail

Right Decisions
Antimicrobial prescribing: NHS Forth Valley
Primary Care Guidance
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SKIN INFECTIONS
Dermatophyte Infection - Nail

Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Dermatophyte infection - nail

CKS

Oral terbinafine is more effective than oral azole.

Liver reactions rare with oral antifungals.

Send nail clippings if treatment failure.

If candida or non-dermatophyte infection confirmed, use oral itraconazole.

Stop treatment when continual, new, healthy, proximal nail growth.

For children, seek specialist advice.

To prevent recurrence: apply weekly 1% topical antifungal cream to entire toe area.

Drug details

First line: terbinafine

250mg OD

fingers: 6-12 weeks

toes: 3-6 months

Second line: itraconazole

200mg BD

7 days monthly

fingers: 2 courses

toes: 3 courses

Third line for very superficial as limited evidence of effectiveness: amorolfine 5% nail lacquer

1-2x/weekly

fingers: 6 months

toes: 12 months