treatment of dermatophyte onychomycosis

Last edited 08/2020

Consider treatments for:

  • distal and localised nail disease

  • more proximal or extensive onychomycosis

Treat only if infection confirmed by laboratory

  • only use topical treatment if superficial infection of the top surface of nail plate For infections with dermatophytes use oral terbinafine or itraconazole
  • for infections with candida or non-dermatophyte moulds use oral itraconazole
  • idiosyncratic liver and other severe reactions occur very rarely with terbinafine and itraconazole
  • for children seek expert advice

Treatments available (1,2)

  • 5% amorolfine nail lacquer
    • 1-2x/weekly
      • fingers for 6 months
      • toes for 12 months
  • terbinafine
    • 250 mg OD
      • fingers for 6-12 weeks
      • toes for 3-6 months
  • itraconazole
    • 200 mg BD
      • fingers for 2 courses of 7 days/month
      • toes for 3 courses of 7 days/month

Reference: