🦶 Fungal Nail Infection
Specific Local Variations to Investigation/Management
The guidelines for management of fungal nails are set out at https://cks.nice.org.uk/topics/fungal-nail-infection/
Local Restriction
Locally, however, fungal nail studies are currently not available. If you send a sample it will be marked on ICE as unprocessed.
This tends to lead to the following management sequence:
1️⃣ First-line: Topical Treatment
- Prescribe amorolfine twice weekly for 6 months
- Add miconazole spray for any athletes foot if present
- Monitor for improvement
2️⃣ Second-line: Oral Treatment
If there are lots of toenails affected, or if the above has been ineffective, then oral treatment with terbinafine:
Oral Treatment Checklist
- Check baseline LFTs in last 3-6 months
- Start terbinafine treatment
- Recheck LFTs every 3 months on treatment
3️⃣ Stopping Treatment
Stop treatment for either topical or oral treatment once there is a band of clear nail proximally.