- Adam O Goldstein, MD, MPH
Adam O Goldstein, MD, MPH
- Department of Family Medicine
- University of North Carolina at Chapel Hill
- Neal Bhatia, MD
Neal Bhatia, MD
- Associate Clinical Professor
- Department of Dermatology, Harbor-UCLA Medical Center
- Section Editors
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — Dermatology
- Professor of Dermatology and Public Health
- Denver VA Medical Center, University of Colorado School of Medicine and Colorado School of Public Health
- Moise L Levy, MD
Moise L Levy, MD
- Section Editor — Pediatric Dermatology
- Professor of Pediatrics and Medicine (Dermatology)
- Dell Medical School, University of Texas, Austin
- Clinical Professor of Dermatology and Pediatrics
- Baylor College of Medicine
- Ted Rosen, MD
Ted Rosen, MD
- Section Editor — Infections and Infestations
- Professor, Department of Dermatology
- Baylor College of Medicine
Onychomycosis, fungal infection of the nail, can cause disfigurement of the nail, pain, and may increase risk for soft tissue bacterial infection in immunocompromised patients. Dermatophytes, particularly Trichophyton rubrum, are the most common causes of onychomycosis. Yeast (eg, Candida albicans) and nondermatophyte molds can also cause onychomycosis. (See "Onychomycosis: Epidemiology, clinical features, and diagnosis".)
Therapeutic options for onychomycosis include oral antifungal medications, topical antifungal medications, and physical interventions. Factors such as the causative organism, severity of nail involvement, treatment side effects, and patient preference influence treatment selection.
The management of onychomycosis will be reviewed here. The clinical features and diagnosis of onychomycosis are reviewed separately. (See "Onychomycosis: Epidemiology, clinical features, and diagnosis".)
APPROACH TO TREATMENT
Patient selection — Treatment of onychomycosis is not mandatory in all patients. We suggest treating onychomycosis in:
●Patients with a history of cellulitis of the lower extremity, especially if repeated, who have ipsilateral toenail onychomycosis
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- APPROACH TO TREATMENT
- Patient selection
- Treatment options
- Pre-treatment diagnostic testing
- DERMATOPHYTE ONYCHOMYCOSIS
- Mild to moderate dermatophyte onychomycosis
- - Oral terbinafine
- - Topical therapy
- Moderate to severe dermatophyte onychomycosis
- - Oral terbinafine
- - Itraconazole
- White superficial onychomycosis
- YEAST AND NONDERMATOPHYTE MOLD ONYCHOMYCOSIS
- SYMPTOM RELIEF
- OTHER THERAPIES
- Alternative oral antifungal drugs
- Photodynamic therapy
- TREATMENT FAILURE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS