Fungal nail and skin infections (Antimicrobial)
TAM (Treatments and Medicines) NHS Highland
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 (ie 4 to 6 weeks)