Onychomycosis (Tinea unguium)
- Terbinafine is more effective than fluconazole or itraconazole.
- Terbinafine cream is NOT effective.
- 25-30% relapse rate.
Usual Pathogens
Trichophyton spp
| Empiric Therapy | Duration | |
|---|---|---|
| Terbinafine | 250mg PO daily | 6 weeks (fingers) / 12 weeks (toes) |
Alternative
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Itraconazole | 200mg PO daily | 12 weeks (fingers, toes) |
Unable to tolerate terbinafine or itraconazole
| Empiric Therapy | Duration | |
|---|---|---|
| Fluconazole | 150-300mg PO once per week | 3-6 months (fingers) / 6-12 months (toes) |
| or | ||
| Efinaconazole 10% topical liquid | Apply once daily | 48 weeks (toes) |