Fungal nail infections

NICE CKS: Fungal nail infection

Treatment for cosmetic reasons is not justified

250mg daily (6 weeks for fingernails or 3 months for toenails)

200mg every 12 hours for 7 days repeated after 21 days: fingernails, 2 courses; toenails, 3 courses

Prescribing Notes:

Refer to NICE CKS: Fungal nail infection.
In view of the long duration of treatment, possible significant side-effects and high costs, cosmetic treatment is not justified. Treatment should not be initiated until mycological confirmation of infection has been received.
Itraconazole and terbinafine have been associated with liver damage.
Topical agents such as amorolfine should be reserved for cases where the infection is confined to the distal edge of the nail in the very early stages of distal and lateral subungual onychomycosis or in superficial white onychomycosis. As superficial infections may not require treatment and topical agents are relatively expensive, it is difficult to justify their use.

History Notes

15/12/2021

East Region Formulary content agreed.

No treatment.

For superficial white distal and lateral nail involvement only.

See BNFc for dose and duration.

Fungal nail infection is rare in children, seek specialist advice from a paediatric dermatologist if oral antifungal treatment is being considered for a child e.g. immunosuppression.

Prescribing Notes:

For management and prescribing information refer to NICE CKS: Fungal nail infection.

History Notes

31/05/2024

Content updated as part of ERF paediatric Skin chapter review.

15/01/2024

East Region Formulary content agreed.