Document type
Clinical pathways
Hertfordshire and West Essex ICB
Output type
Clinical Pathways
Fungal Nail Management

Fungal Nail Management

Pathway Publish Date: March 2023
Pathway Next Review Date: March 2025

Conduct full history and examination as per pathway and provide foot care advice. 

  • If cosmetic symptoms only do not prescribe - signpost patient to local pharmacy for medicated nail paint or lacquer
  • Treat ONLY if significant symptoms (oral treatment for patients over 18):
    • Significant pain
    • Secondary infection (cellulitis)
    • Functional impairment

Or where patient is at significant risk of complications due to:

  • diabetes
  • peripheral vascular disease
  • immunosuppression

NB: before treatment is commenced diagnosis must be confirmed with nail scrapings or clippings

  • In high risk patients in patients with significant symptoms or risk if nails are traumatised or deformed nails traumatising adjacent toes consider referral to podiatry for nail surgery
  • Consider referral (to skin health triage/paediatrics) if:
    • child under 18 needing oral medication
    • uncertain diagnosis
    • unsuccessful treatment
    • immunocompromised patient