TINEA UNGUIUM

Fungal infection of the nails is common, especially of the toenails in the
elderly, where it generally does not require treatment. There may be a
mixed fungal and yeast infection of toenails and /or fingernails.
Chronic paronychia is a chronic inflammation of the skin around the nail
caused by mixed or yeast infections. It often occurs in people who frequently
wet their hands such as domestic workers, cleaners, kitchen and
laundry staff.
Management of tinea unguium
Infection of the toenails:
- Usually this does not require any treatment. Thickened toenails may be softened using
Whitfield’s ointment or urea 10 to 40% ointment, and then thinned with a stone or a file.
- Systemic treatment of infected toenails is sometimes indicated e.g. when there is
pain or when the patient is young; griseofulvin 500 mg once daily until the affected
nails have grown out completely, this may take a year or longer. Recurrences are
common, take this into account when deciding whether to use one of the more
expensive drugs as listed below for infection of the fingernails.
Infection of the fingernails:
- Griseofulvin 500 mg once daily in adults or griseofulvin 10 mg/kg once daily in
children. Continue treatment until the affected nails have grown out completely,
this may take 4-9 months.
- If there is no improvement after 2-4
months, there may be a mixed infection
(griseofulvin treats only fungal infections,
not yeast infections) or resistance to
griseofulvin. One of the systemic azoles
should be given, e.g. ketaconazole 200 mg
once daily until symptoms clear or
itraconazole 200 mg once daily for
3 months or itraconazole 200 mg twice
daily for 1 week per month during
3 months. Alternative: terbinafine 250 mg
once daily for 6-16 weeks.
Chronic paronychia: Keep dry! Work
conditions may need adapting. Bathe in
betadine or potassium permanganate
solution followed by application of an
imidazole cream or GV paint twice daily.
Massaging the nailfold with a mild steroid
helps decrease swelling.
Fig. 24. Fungal infection
of the hand and nails.