Fungal nail infections

Question 1

Where do fungal nail infections normally present?

Answer 1

• Any part of the nail or entire nail unit, usually more likely in the toenails

Question 2

What organisms cause fungal nail infections?

Answer 2

• Most common: dermatophytes: Trichophyton rubrum
• Yeats e.g. Candida

Question 3

What are the risk factors for fungal nail infections?

Answer 3

• Increasing age
• Diabetes Mellitus
• Psoriasis
• Repeated nail trauma

Question 4

How do nail infections present?

Answer 4

• Patients often complain of unsightly nails
• Thickened, rough and opaque nails are the most common finding

Question 5

How should nail infections be investigated?

Answer 5

• Nail clippings with scrapings of the affected nail should be sent for microscopy and culture if anti-fungal treatment is being considered
• Repeat samples may be needed if highly suggested

Question 6

How are nail infections managed?

Answer 6

• No treatment needed if asymptomatic
• If limited involvement: topical treatment with amorolfine 5% nail lacquer for 9-12 months if toenails, 6 months if fingernails
• If more extensive dermatophyte: oral terbinafine for 3-6 months for toenails, 3 months for finernails
• If more extensive candida, oral itraconazole weekly therapy needed