Fungal nail infection

NICE Clinical Knowledge Summaries - Fungal nail infection

Antifungal treatment is not needed if:

• • The person is not troubled by the appearance of the nail(s), and/or
  • Infection is asymptomatic.

Offer self-care and prevention advice to all patients

• • Keep nails trimmed short and filed down.
  • Avoid sharing toenail clippers with family members.
  • Wear well-fitting non-occlusive shoes, without high heels or narrow toes. Consider replacing old footwear that could be contaminated with fungal spores.
  • Wear cotton, absorbent socks.
  • Maintain good foot hygiene, including prompt treatment of any associated tinea pedis. 
  • Wear protective footwear when using communal bathing places, locker rooms, and gymnasiums, to avoid re-exposure.
  • Avoid prolonged or frequent exposure to warm, damp conditions if possible.
  • Avoid trauma to the nails if possible.

Offer treatment with an oral antifungal agent if an adult has confirmed fungal nail infection and self-care measures alone and/or topical treatment are not successful or appropriate.

Oral terbinafine is more effective than oral azole.

Visible improvement may be seen after 2 months of fingernail treatment and 3 months of toenail treatment

Liver reactions rare with oral antifungals.

Stop treatment when continual, new, healthy, proximal nail growth.

For children, seek specialist advice.

To prevent recurrence: apply weekly 1% topical antifungal cream to entire toe area.