Topical and oral treatment can work for fungal nail infections

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Goodfellow Gems

Topical and oral treatment can work for fungal nail infection

A recent Alberta Tools for Practice1 summarises that up to 45-60% of patients on oral treatments for fungal nail infections (terbinafine best;  NNT=3 and placebo 6%) will be "cured" after ~1 year with 12 to 16 weeks of treatment.

Re terbinafine versus "azoles" (mostly itraconazole), 58% cure with terbinafine, 46% azole; NNT=9. Risk of terbinafine-induced liver injury: ~1 in 50,000-120,000 prescriptions, and taste loss in 0.6 - 2.8% of those taking the drug.2 Advise patient to stop taking at first sign of taste loss as it's usually reversible.

Topicals should be reserved for cases with minimal (<40%) nail involvement. Improvement is 6-23% on topicals (efinaconazole best but not available in NZ, ciclopirox is available in NZ; NNT to get cure 15-23 and treat for up to 48 weeks). Amorolfine is available in NZ but no data was presented.


  1. Putting the FUN in Fungi: Toenail onychomycosis treatments. Alberta Tools for Practice #242. View here
  2. Objective assessment of terbinafine-induced taste loss. Laryngoscope (2005). View here

Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.

As published in NZ Doctor 23/10/2019