Onychomycosis

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It is defined as infection of the nail plate by fungus. Patients with diabetes or peripheral neuropathy  may be at a higher risk. 

Clinical presentation

• Yellowish discoloration of the nail
• Subungual hyperkeratosis
• Over time lesions become more prominent and spread until the entire nail is affected

Investigations 

• LFT before starting treatment and monitoring monthly

Pharmacological Treatment 

A: fluconazole (PO) 150-300mg once weekly for 6–12months 

OR 

C: terbinafine (PO) 250mg 24hourly for 6-8weeks. For toe nails the duration of treatment is generally 12–16weeks 

OR 

D: itraconazole (PO) 200mg 12hourly for 7days is given as pulsed dosing, of each month for 6months 

Note: Terbinafine and itraconazole should not be used in pregnancy and while breastfeeding