From the Guidelines
The recommended treatment for trichophyton nail infection (onychomycosis) is oral terbinafine (250 mg daily for 6-12 weeks for fingernails or 12-16 weeks for toenails) due to its higher efficacy and tolerability compared to other options. This is based on the guidelines from the British Association of Dermatologists 1, which suggest that terbinafine should be considered as the first choice for treatment of dermatophyte onychomycosis, unless there are contraindications.
Treatment Options
- Oral terbinafine: 250 mg daily for 6-12 weeks for fingernails or 12-16 weeks for toenails 1
- Oral itraconazole: 200 mg twice daily for 1 week per month, repeated for 2 months for fingernails or 3 months for toenails 1
- Topical ciclopirox 8% nail lacquer: applied daily for up to 48 weeks 1
- Topical efinaconazole 10% solution: applied daily for 48 weeks (though not mentioned in the provided evidence, it is an option for mild cases)
Prevention of Recurrence
- Good nail hygiene: keeping nails short, dry, and clean
- Avoiding sharing nail tools
- Applying antifungal powders containing miconazole, clotrimazole, or tolnaftate in shoes and on the feet
- Wearing cotton, absorbent socks
- Discarding old and mouldy footwear or treating them with naphthalene mothballs or a terbinafine solution 1
Important Considerations
- Complete cure requires patience as nails grow slowly, with fingernails taking 4-6 months and toenails 12-18 months to fully replace
- Treatment works by inhibiting ergosterol synthesis in the fungal cell membrane, preventing fungal growth and allowing healthy nail to grow out
- In severe cases resistant to medication, nail removal might be considered to allow direct application of antifungals to the nail bed 1
From the FDA Drug Label
The comprehensive management program includes removal of the unattached, infected nails as frequently as monthly, by a health care professional who has special competence in the diagnosis and treatment of nail disorders, including minor nail procedures. Ciclopirox Topical Solution, 8%, (Nail Lacquer), as a component of a comprehensive management program, is indicated as topical treatment in immunocompetent patients with mild to moderate onychomycosis of fingernails and toenails without lunula involvement, due to Trichophyton rubrum Terbinafine tablets, USP are indicated for the treatment of onychomycosis of the toenail or fingernail due to dermatophytes (tinea unguium).
The recommended treatment for Trichophyton nail infection is:
- Topical treatment: Ciclopirox Topical Solution, 8%, (Nail Lacquer) as part of a comprehensive management program, which includes removal of the unattached, infected nails as frequently as monthly, by a health care professional.
- Oral treatment: Terbinafine tablets, USP, for the treatment of onychomycosis of the toenail or fingernail due to dermatophytes (tinea unguium) 2, 3. Key points to consider:
- The treatment should be used under medical supervision.
- The comprehensive management program is necessary to achieve maximum benefit.
- Removal of the unattached, infected nail is required as frequently as monthly.
- Terbinafine can be used for the treatment of onychomycosis of the toenail or fingernail due to dermatophytes (tinea unguium).
From the Research
Treatment Options for Trichophyton Nail Infection
The recommended treatment for trichophyton nail infection includes several oral antifungal medications, such as:
- Itraconazole
- Terbinafine
- Fluconazole
Efficacy of Treatment Options
Studies have shown that:
- Terbinafine is effective against dermatophytes, with a cure rate of 93% when pulse-dosed for 7 days every 3 months 4
- Itraconazole has a broad spectrum of action and can be detected in nails 1 to 2 weeks after the start of therapy, with a cure rate of 45.8% at week 48 5
- Fluconazole has a high oral bioavailability and can exceed the minimum inhibitory concentration (MIC) for Candida species soon after the start of treatment 6
Treatment Regimens
The following treatment regimens have been studied:
- Terbinafine 250mg daily for 3 months 6
- Itraconazole 100 to 200 mg daily for at least 6 months 6
- Fluconazole 150 mg weekly for at least 6 months 6
- Pulse-dosed terbinafine for 7 days every 2-4 months 4
Safety and Tolerability
The safety and tolerability of these medications have been evaluated, with: