From the Guidelines
Terbinafine 250mg daily for 6 weeks is the recommended treatment for index finger onychomycosis due to its higher efficacy and tolerability compared to other options. This recommendation is based on the British Association of Dermatologists' guidelines for the management of onychomycosis 2014 1. The guidelines suggest that terbinafine should be considered as the first choice of treatment unless there are contraindications.
Some key points to consider when treating index finger onychomycosis include:
- Terbinafine has been shown to be more effective than itraconazole in several large studies, with complete cure rates of 55% compared to 26% for pulsed itraconazole at 72 weeks follow-up 1.
- Itraconazole is an alternative option, licensed at a dose of 200mg per day for 12 weeks continuously, or as pulse therapy at a dose of 400mg per day for 1 week per month, with two pulses recommended for fingernail onychomycosis 1.
- Treatment should continue until the infected nail has grown out completely, and patients should be re-evaluated 3-6 months after treatment initiation to determine if further treatment is needed 1.
- Mechanical debridement of the affected nail and good nail hygiene practices, such as keeping nails short, dry, and clean, can improve treatment outcomes 1.
Overall, the goal of treatment is to achieve a complete cure, defined as negative mycological analysis and a normal nail, while minimizing the risk of relapse and promoting good nail health.
From the FDA Drug Label
Terbinafine tablets, USP are indicated for the treatment of onychomycosis of the toenail or fingernail due to dermatophytes (tinea unguium). Fingernail onychomycosis: One 250 mg tablet once daily for 6 weeks.
The treatment for index finger onychomycosis is terbinafine (PO), with a recommended dosage of one 250 mg tablet once daily for 6 weeks 2.
- Key points:
- The diagnosis of onychomycosis should be confirmed by laboratory testing before initiating treatment.
- The optimal clinical effect is seen some months after mycological cure and cessation of treatment.
From the Research
Treatment Options for Index Finger Onychomycosis
- Oral terbinafine has been shown to be effective in treating onychomycosis, including finger onychomycosis, with a study demonstrating that 250 mg daily for 6 months resulted in all 11 patients being clinically and mycologically normal 3.
- The use of oral terbinafine has been compared to other treatments, such as itraconazole, fluconazole, and griseofulvin, and has been found to be more efficacious in dermatophyte onychomycosis of the toenails 4.
- Topical treatments, such as amorolfine and ciclopirox, have also been shown to be effective in treating onychomycosis, particularly for mild to moderate cases 5, 6.
- Combination therapy with oral terbinafine and topical amorolfine has been found to be beneficial in treating onychomycosis, particularly for non-dermatophyte fungi such as Scopulariopsis brevicaulis 5.
Considerations for Treatment
- The choice of treatment should be based on the severity of the onychomycosis, with topical treatments and debridement recommended for mild to moderate cases, and systemic therapy (such as terbinafine) recommended for more severe cases 6.
- The potential for drug interactions and side effects should be considered when selecting a treatment, with terbinafine having a low potential for drug interactions and a good tolerability profile 4.
- Treatment duration can vary from 3 to 9 months, and strategies for treatment should be individualized based on the patient's specific needs and circumstances 6.