# Nail problems - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Loceryl 5% w/v Medicated Nail Lacquer SmPC sections 4.1, 4.2 and 4.4 (eMC product 1411) · No dose - assessment step, no medicine given · Bodman MA, Syed HA, Krishnamurthy K. Onychomycosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last Update: November 6, 2025. · UK eMC Terbinafine 250mg Tablet SmPC (Aurobindo Pharma - Milpharm Ltd.), product id 7133 - Verified date: 2026-08 ## Verified against - Loceryl 5% w/v Medicated Nail Lacquer SmPC sections 4.1, 4.2 and 4.4 (eMC product 1411) - No dose - assessment step, no medicine given - UK eMC Terbinafine 250mg Tablet SmPC (Aurobindo Pharma - Milpharm Ltd.), product id 7133 ## Treatment metadata - No drug therapy in primary care (Assess first) - Amorolfine — topical ## Complete treatment card ```text NAIL PROBLEMS Sources: Loceryl 5% w/v Medicated Nail Lacquer SmPC sections 4.1, 4.2 and 4.4 (eMC product 1411) · No dose - assessment step, no medicine given · Bodman MA, Syed HA, Krishnamurthy K. Onychomycosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last Update: November 6, 2025. · UK eMC Terbinafine 250mg Tablet SmPC (Aurobindo Pharma - Milpharm Ltd.), product id 7133 Review status: REVIEWED against 3 sources listed above (2026-08) 1. NO DRUG THERAPY IN PRIMARY CARE (ASSESS FIRST) [1st line] Adult Confirm what it is before treating it. Fewer than half of thickened, discoloured nails are fungal - psoriasis, repeated trauma, lichen planus and chronic paronychia all look the same. Where it matters, and always before committing to a months-long antifungal course, send nail clippings for microscopy and culture. Look at all twenty nails, the nail folds, and the skin of the soles, palms, scalp and elbows. - Assess, then decide Peds Nail changes in children are far more often trauma, nail biting or eczema than fungus. Amorolfine lacquer is not for children; confirmed onychomycosis in a child should be referred. Source No dose - assessment step, no medicine given Why An oral antifungal course runs for months and needs liver monitoring; a lacquer runs for up to a year. Neither is worth starting on a guess, and a nail that was never fungal will not improve - which then gets read as treatment failure rather than as the wrong diagnosis. Caution A single new dark streak running the length of one nail, particularly if the pigment spreads onto the nail fold, is subungual melanoma until proved otherwise. Refer urgently. Clubbing is not a nail disease. It points at the chest, the heart or the bowel - examine accordingly. Pitting, oil-drop discolouration and onycholysis across several nails is psoriasis. An antifungal will do nothing for it. A painful red swollen nail fold is paronychia. That is treated as an infection or drained, not with an antifungal. In a diabetic or anyone with poor circulation, a thickened nail is a foot-care problem first - refer to podiatry, and never let a patient cut it back aggressively themselves. Brittle, spooned or ridged nails: check ferritin and thyroid function rather than reaching for a topical. 2. AMOROLFINE [2nd line] Adult Apply the 5% lacquer once weekly to the affected nail, after filing the nail surface down as thoroughly as possible and cleansing it with the supplied pad. Twice weekly suits some patients. - About 6 months for fingernails and 9-12 months for toenails, reviewing every 3 months Peds The label states plainly that children should not be treated with amorolfine 5% nail lacquer. Source Loceryl 5% w/v Medicated Nail Lacquer SmPC sections 4.1, 4.2 and 4.4 (eMC product 1411) Why The option when onychomycosis is confirmed, limited to the far end of one or two nails, and the nail matrix is untouched. It avoids the drug interactions and liver monitoring that come with a months-long course of oral terbinafine, at the cost of working more slowly and less well. Terbinafine's own UK label (section 4.4) sets out that monitoring: it calls for a liver function test before starting, warns that hepatotoxicity can occur whether or not liver disease already exists, and recommends checking liver function again periodically, from 4 to 6 weeks into treatment. Caution The label says children should not be treated with this lacquer. Filing the nail down before the first application is not optional. The lacquer cannot reach the infection through an unfiled plate. Do not apply it to the skin around the nail, and keep it away from the eyes, ears and mucous membranes. Not to be used in pregnancy or while breastfeeding unless clearly necessary. It contains 55.2% ethanol and is flammable - keep it away from a flame. No artificial nails while treating. Extensive disease, involvement of the nail matrix, or more than two or three affected nails needs an oral antifungal, not a lacquer. Warn the patient at the start that the nail will not look normal for the best part of a year - the drug clears the infection, and then the nail has to grow out. The Egyptian register records no route for the amorolfine lacquer, so it is marked 'different route - not topical'. Ignore that mark: the product is a nail lacquer, which is exactly what is wanted here. Egypt AMOROLFINE 5% NAIL LACQUER WITH SPATULAS AND NAIL FILES CHANELLE PHARMAC... 92.50 EGP -> ? different route - not topical Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)