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Fungal nail infection (onychomycosis) - Management
Should I treat a fungal nail infection?

  • Self care alone may be appropriate for people who are not bothered by the infected nail or who wish to avoid the possible adverse effects of drug treatment.
  • Consider drug treatment if:
    • Walking is uncomfortable.
    • Abnormal-looking nails are causing significant psychological distress.
    • The person has diabetes, vascular disease, or a connective tissue disorder (because of a higher risk for secondary bacterial infections and cellulitis).
    • The nail infection is thought to be the source of fungal skin infection.
    • The person is, or is likely to become, severely immunocompromised (for example with haematological malignancy or its treatment).
  • Discuss the likely benefits and adverse effects of treatment so the person can make a fully informed choice.
    • Treatment does not always cure the infection. Cure rates range between approximately 60–80%.
    • Treatment that eradicates the infection sometimes does not restore the nail's appearance to normal.
    • The drugs need to be taken for several months, or longer for resistant nails.
    • Unpleasant adverse effects can occur. These include headache, itching, loss of the sense of taste, gastrointestinal symptoms, rash, and fatigue. Although abnormal liver function tests are not uncommon, liver failure and other serious adverse effects are rare.

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