DR Medhat MRCP

Fungal nail infections (Onychomycosis)
Causes Features Investigations
Dermatophytes – mainly Unsightly' nails are a Nail clippings.
Trichophyton rubrum, common reason for Scrapings of the
90% of cases.
presentation.
affected nail
Yeasts - such as Candida
Non-dermatophyte
moulds
Thickened, rough,
opaque nails are the most
common finding
• Management :
Diagnosis should be confirmed by microbiology before starting treatment
1) Dermatophyte infection :
Oral terbinafine : 1 st line ttt.
Fingernail : ttt x 6 weeks.
Oral itraconazole : alternative ttt. Toenail : ttt x 12 weeks .
2) Candida infection :
Mild infection : topical antifungals (e.g amorolfine).
Severe infection : oral itraconazole for 12 weeks.
Onychomycosis of toenails
Candidal onychomycosis of fingernails
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