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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.

Fungal Nail Infections

Not all treatment options may be listed in this guidance. Please refer to local formulary for a complete list.

Treatment/ therapy

  • Fungal nail infection 
  • Yellowish discolouration 
  • Soft subungual hyperkeratosis 
  • Spread from distal edge 
  • Superficial white onychomycosis 

Fungal nail infection

Fungal nail infection

Funal nail infection

Perform mycological examination of nail clippings INCLUDING soft subungual material to detect fungal elements. 

Do not prescribe systemic antifungal drugs without laboratory confirmation of the diagnosis. 

Dermatophyte nail infection 

  • No treatment is an option especially in the elderly - regular podiatry if required 
  • Terbinafine 250mg od for six weeks for finger and 12–16 weeks for toe nails and review progress. Caution in patients with liver and auto- immune diseases 
  • Itraconazole 200mg bd for one week pulsed monthly for two courses (fingernail) or three courses (toenail) 
  • Topical amorolfine lacquer for superficial white distal and lateral nail involvement only

Referral Management

Dermatology Referral Criteria 

  • Diagnosis uncertain 
  • Suspicion of subungual tumour 
  • Failure of fungal nail infections to respond to treatment 

Consider referral to podiatrist 

  • Toe nail dystrophy secondary to trauma 
  • Painful psoriatic toe nails 

Differential Diagnosis

Subungual haematoma 

  • History of trauma 
  • Discolouration migrates with nail growth 

Subungual haematoma

Chronic paronychia 

  • Rounded nail folds with loss of cuticle and ridged nail 
  • Treat with clotrimazole cream four × daily 
  • Protect hands with gloves for wet work 

Chronic Paronychia

Psoriasis 

Pitting and onycholysis 

Psoriasis

Patient information resources

Editorial Information

Author(s): Adapted from Dermatology Patient Pathways .

Co-Author(s): NHS Scotland, Scottish Dermatology Society.