Tinea unguium

A. Tinea unguium is a dermatophyte infection of the nails. It is a subset of onychomycosis, which includes dermatophyte, nondermatophyte and yeast infections of the nails. Toenails are involved more frequently than fingernails. Risk factors for this fungal infection include increasing age, diabetes, poor venous and lymphatic drainage, ill-fitting shoes, and sports participation. Involvement of the toenail usually is extremely resistant to treatment and has a tendency to recur. Chemical or surgical avulsion may be helpful in recalcitrant infection.

B. With distal involvement, the affected nail is hyperkeratotic, chalky and dull. The brownish-yellow debris that forms beneath the nail causes the nail to separate from its bed. Coexistent tinea manuum or tinea pedis is common.

C. Tinea unguium requires oral itraconazole or terbinafine. Itraconazole "pulse" therapy (ie, a series of brief medication courses) is recommended for tinea unguium of the fingernails and toenails. Terbinafine pulse therapy may also be effective. Fluconazole may be another alternative.

Topical Treatments for Tinea Pedis, Tinea Cruris and Tinea Corporis

Antifungal agent

Prescription

Cream

Solution or spray

Lotion

Powder

Friquincy of application

Imidazoles |

Clotrimazole 1 percent (Lotrimin, Mycelex)

X

X

X

Twice daily

Miconazole 2 percent (Micatin, Monistat-Derm)

X

X

X

X

Twice d aily

Econazole 1 percent (Spectazole)

X

X

Once daily

Ketoconazole 2 percent (Nizoral)

X

X

X

Once daily

Oxiconazole 1 percent (Oxistat)

X

X

X

Once daily or twice daily

Allylaminis |

Naftifine 1 percent (Naftin)

X

X

Once daily or twice daily

Terbinafine 1 percent (Lamisil)

X

X

X

Once daily or twice daily

Recommended Dosages and Durations of Oral Therapy for Tinea Infections

Antifungal agent

Tinea capitis

Tinea corporis/cruris

Tinea pedis

Tinea unguium Fingernails

Tinea unguium Toenails

Terbinafine (Lamisil)

Adults: 250 mg per day for four to six weeks Children: 3 to 6 mg per kg per day for six weeks

Adults: 250 mg per day for one to four weeks

250 mg per day for two to six weeks

Continuous: 250 mg per day for six weeks Pulse: 500 mg per day for one week on, three weeks off, for a total of two months

Continuous: 250 mg per day for 12 weeks Pulse: 500 mg per day for one week on, three weeks off, for a total of four months

Itraconazole (Sporanox)

Adults: 100 mg per day for six weeks Children: 3 to 5 mg per kg per day for four to six weeks

100 mg per day for two weeks or 200 mg per day for two weeks or 200 mg per day for one to two weeks

100 mg per day for four weeks

Continuous: 200 mg per day for six weeks Pulse: 200 mg twice daily for one week on, three weeks off, for two months

Continuous: 200 mg per day for 12 weeks Pulse: 200 mg twice daily for one week on, three weeks off, for three to four months

Fluconazole (Diflucan)

50 mg per day for three weeks

150 mg weekly for two to four weeks

150 mg weekly for two to six weeks

Not recommended

Not recommended

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