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Fungal nail and skin infections (Antimicrobial)



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.


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


Topical terbinafine 1% cream. Apply twice daily

7 days


OR clotrimazole 1% cream. Apply twice daily.

1 to 2 weeks after healing (ie 4 to 6 weeks)

Last reviewed: 23/05/2019

Next review date: 30/05/2022

Author(s): Antimicrobial Management Team.

Approved By: TAM Subgroup of ADTC

Reviewer name(s): Area Antimicrobial Pharmacist.

Document Id: AMT165