Fungal Nail Infections

Question 1

What are the symptoms of fungal nail infections?

Answer 1

Thickened, chalky, discoloured (yellow-white) and brittle nails which eventually separate from the nail bed and disintegrate.

Question 2

Do fungal nail infections require a counselling room?

Answer 2

Yes

Question 3

What are 6 red flags for referral with fungal nail infections?

Answer 3

1. Involvement of the entire nail matrix
2. OTC Treatment Failure
3. Suspected poor compliance
4. Other forms of fungal infection.
5. Suspected bacterial infection.
6. Diabetic or immunocompromised patient.

Question 4

Do fungal nail infections have a PSA self-care card?

Answer 4

No

Question 5

What is the preferred over-the-counter treatment option for fungal nail infections?

Answer 5

Amorolfine 5% w/v (Loceryl®) nail lacquer

Question 6

What are the directions for Amorolfine 5% w/v (Loceryl®) nail lacquer in fungal nail infections?

Answer 6

Adults and Children over 12 years:
1. File down infected areas on an infected nail (don’t use the same file on healthy nails afterwards)
2. Clean the nail surface with a cleaning pad
3. Dip spatula into lacquer
4. Paint over the entire nail surface
5. Close bottle tightly
6. Allow 3-5mins for nails to dry
7. Clean spatula and neck of bottle with same cleaning pad
8. Apply ONCE or TWICE weekly to the affected nail.
9. Treatment takes around 6 months for fingernails and 9-12 months for toe nails.
10. Continued until the infected nails are completely regrown.
11. If there is minimal to nil improvement after 6 months of treatment ➔ Refer to GP.

Question 7

What are 2 non-preferred over-the-counter options for fungal nail infections and why?

Answer 7

1. Ciclopirox (RejuveNail): Applied daily
2. Miconazole Tincture (Daktarin): Poor nail bed perfusion

Question 8

Is Amorolfine 5% w/v (Loceryl®) nail lacquer safe in pregnancy?

Answer 8

No

Question 9

Is Amorolfine 5% w/v (Loceryl®) nail lacquer safe in breastfeeding?

Answer 9

No

Question 10

What is the age range for Amorolfine 5% w/v (Loceryl®) nail lacquer?

Answer 10

Safe in children over 12

Question 11

What are 3 pieces of non-pharmacological advice for fungal nail infections?

Answer 11

1. Each pack provides treatment for 3 months, which allows the pharmacist an opportunity to review treatment before further medication is given
2. Very expensive product!!! ~ $70- 80 per 3 months treatment with treatment often greater than 12 months in duration.
3. If patient unlikely to commit to treatment duration would be best to refer to GP for systemic oral anti-fungal treatment i.e., Terbinafine.

Question 12

What are 3 practice points to consider with fungal nail infections?

Answer 12

1. Often associated with chronic or recurrent tinea pedis.
2. Approximately half of those affected experience pain.
3. Incidence increases with age