Document type

Clinical pathways

Place

Hertfordshire and West Essex ICB

Output type

Clinical Pathways

Pathway

Fungal Nail Management

Fungal Nail Management

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