Helen is a 60 year old receptionist who presents with 2 months of toenail discolouration and hypertrophy. She has a background of alcoholic liver disease.

What is the most likely cause?

1. Onychomycosis

What are the causes of onychomycosis?

1. Trichophyton mentagrophytes
2. Trichophyton rubrum

What is the management of onychomycosis?

1. Terbinafine 259mg orally 12 weeks
   •  – cures 80%
   • – 6 weeks for fingernails
   • Takes 12 months for toenail to grow
2. Topical amorolfine 5% nail lacquer 1-2 times weekly after filing

What are the Relative contraindications for Terbinafine?

1. Chronic or active liver disease
2. Anaphylaxis
3. Discontinue if biochemical or physical signs of liver dysfunction

Reading

1. Murtaghs General Practice Chapter 129 – http://murtagh.mhmedical.com/content.aspx?bookid=1522&sectionid=116046129
2. Murtaghs Practice Tips – Chapter 8 – Nail Problems – http://murtagh.mhmedical.com/content.aspx?bookid=1920&sectionid=143276631

Podcast

1. GP Core Content Podcast Episode 150 – Dermatology | Nails