Fungal nail and skin infections (Antimicrobial)

Warning

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)

Editorial Information

Last reviewed: 28/03/2024

Next review date: 28/03/2027

Author(s): Antimicrobial Management Team.

Version: 2

Approved By: TAM Subgroup of ADTC

Reviewer name(s): Alison Macdonald, Area Antimicrobial Pharmacist.

Document Id: AMT165