# Onychomycosis (Fungal Nail Infection) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - antimicrobial-2023.pdf, Itraconazole monograph (chapter PDF p55) · Egyptian National Drug Formulary - antimicrobial-2023.pdf, Terbinafine monograph (chapter PDF p415) · Egyptian National Drug Formulary 2023 — Antimicrobial, Itraconazole monograph, Onychomycosis (antimicrobial-2023.pdf, page index 55, printed p46) · Bodman MA, Syed HA, Krishnamurthy K. Onychomycosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2025 Nov 6. Bookshelf ID: NBK441853. - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - antimicrobial-2023.pdf, Terbinafine monograph (chapter PDF p415) - Egyptian National Drug Formulary 2023 — Antimicrobial, Itraconazole monograph, Onychomycosis (antimicrobial-2023.pdf, page index 55, printed p46) - Bodman MA, Syed HA, Krishnamurthy K. Onychomycosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2025 Nov 6. Bookshelf ID: NBK441853. ## Treatment metadata - Terbinafine — oral.solid - Itraconazole — oral.solid ## Complete treatment card ```text ONYCHOMYCOSIS (FUNGAL NAIL INFECTION) Sources: Egyptian National Drug Formulary - antimicrobial-2023.pdf, Itraconazole monograph (chapter PDF p55) · Egyptian National Drug Formulary - antimicrobial-2023.pdf, Terbinafine monograph (chapter PDF p415) · Egyptian National Drug Formulary 2023 — Antimicrobial, Itraconazole monograph, Onychomycosis (antimicrobial-2023.pdf, page index 55, printed p46) · Bodman MA, Syed HA, Krishnamurthy K. Onychomycosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2025 Nov 6. Bookshelf ID: NBK441853. Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SIGNS - what you find (6) - One or more toenails, usually a great toenail, appear thickened and discolored - Mild dry, scaly skin on the sole is often overlooked concurrent tinea pedis, mistaken for simple dryness [scaling] - Distal lateral subungual onychomycosis shows partial lifting of the nail from its bed with thickening or crumbling underneath - White superficial onychomycosis appears as chalky white deposits on the nail surface - Total dystrophic onychomycosis, the most advanced form, shows heavy thickening under the nail with destruction of the nail plate and bed ridging - Dermoscopy showing fine spikes and lengthwise streaks under the nail points to fungal infection rather than simple nail dystrophy TESTS (5) - A potassium hydroxide wet-mount of nail scrapings is only about 60% sensitive, but a positive result can separate a true fungus from a contaminant - A PAS-stained nail clip biopsy read by a pathologist is the most sensitive test, at about 95% - Fungal culture is very specific but only around 60% sensitive, and results take weeks to grow - PCR testing raises dermatophyte detection by about 20% compared with culture alone - Roughly half of abnormal-looking toenails turn out not to be fungal, so mycology testing is needed before treating IF NOT THIS - what else fits (6) - Yellow nail syndrome is named as a mimic of onychomycosis - A drug reaction can produce nail changes resembling fungal infection - Hypothyroidism is listed among the conditions that can resemble onychomycosis - Nail malignancy must be distinguished from onychomycosis - Psoriatic nail changes are on the differential for onychomycosis - Contact dermatitis of the nail fold is on the differential Source StatPearls "Onychomycosis" - disease-level clinical article Status traced to the source above 1. TERBINAFINE [1st line] Adult 250 mg orally once daily. x 6 weeks for a fingernail infection, or 12 weeks for a toenail infection. Peds Paediatric dosing is specialist-set and is not reproduced here. Source Egyptian National Drug Formulary - antimicrobial-2023.pdf, Terbinafine monograph (chapter PDF p415) Why Terbinafine is the formulary's oral first-line agent for dermatophyte onychomycosis, the most common cause of thickened, discoloured nails, and its own text notes other agents are preferred only when the cause is not a dermatophyte. Caution Confirm the diagnosis with nail clipping microscopy/culture before committing to a multi-week course. Hepatotoxicity risk - baseline and periodic liver function tests are advisable for a course this long; avoid in active liver disease. A diabetic patient with nail or surrounding skin infection needs closer monitoring for complications. Spreading cellulitis around the nail needs antibacterial treatment and reassessment, not an antifungal alone. Egypt TRERBI 250 MG 10 TAB. MASH PREMIERE 26.40 EGP (2.64/unit) MYCOMIC 250 MG 10 TAB. FUTURE PHARMA... 26.50 EGP (2.65/unit) MYCOMIC 250 MG 20 TABS. FUTURE PHARMA... 53.00 EGP (2.65/unit) UNITOPFIN 250 MG 7 F.C. TABS. UNIPHARMA CO.... 25.20 EGP (3.60/unit) FUNGISAFE 250MG 7 TAB. AMOUN 32.00 EGP (4.57/unit) LAMIFEN 250 MG 14 TABS. EGPI 112.00 EGP (8.00/unit) TERBINASIL 250 MG 7 TAB. JAMJOOM PHARM... 68.00 EGP (9.71/unit) LAMISIL 250MG 14 TAB. NOVARTIS 146.50 EGP (10.46/unit) LAMISIL ONCE 4G FILM FORMING SOLUTION. NOVARTIS 50.00 EGP -> ? strength differs, ? different route - not oral solid 2. ITRACONAZOLE [2nd line] Adult Continuous dosing: 200 mg orally once daily for 6 weeks or 12 weeks. Alternative pulsed dosing: 200 mg orally twice daily for 1 week, repeated every 4 weeks, for 2 months or 3 months. x 6 or 12 weeks continuous, or 2 or 3 pulsed months — the formulary gives both figures without saying which nail gets which Peds Paediatric dosing is specialist-set and is not reproduced here. Source Egyptian National Drug Formulary 2023 — Antimicrobial, Itraconazole monograph, Onychomycosis (antimicrobial-2023.pdf, page index 55, printed p46) Why The formulary itself notes other agents (i.e. terbinafine) are preferred for dermatophyte onychomycosis, making itraconazole the second-line oral option, useful when terbinafine is unsuitable or the infection is non-dermatophyte. Caution Capsules and oral solution are not interchangeable; give capsules after food, swallowed whole, and not with antacids. Obtain liver function tests in patients with pre-existing liver disease and in anyone treated for longer than a month. Contraindicated for onychomycosis in anyone with ventricular dysfunction or a history of congestive heart failure, and in women who are pregnant or contemplating pregnancy. The formulary notes other agents are preferred for dermatophyte onychomycosis. The formulary does not state which duration is for fingernail and which for toenail. Longer courses are conventionally used for toenail, but the formulary does not say so. Numerous drug interactions via CYP3A4 (some statins, benzodiazepines, and other drugs) - review all concurrent medications before prescribing. Contraindicated in heart failure with reduced ejection fraction; discontinue if signs or symptoms of heart failure occur. Hepatotoxicity risk - monitor liver function on longer or repeated courses. Avoid in pregnancy. A diabetic patient with nail or surrounding skin infection needs closer monitoring for complications. Egypt FUNGITRANAZOLE 100 MG 10 CAPS. DEBEIKY 32.00 EGP (3.20/unit) ITRAFUNGIZOLE 100 MG 12 CAPS. AL ROWAD PHAR... 42.00 EGP (3.50/unit) FUNGITRANAZOLE 100 MG 4 CAPS. DEBEIKY 15.60 EGP (3.90/unit) AROZOLE 100MG 4CAPS. ALFACURE PHAR... 19.20 EGP (4.80/unit) ITRANOX 100 MG 5 CAPS. ADWIA 36.00 EGP (7.20/unit) ITRAFUNGEX 100 MG 4 CAPS. FUTURE PHARMA... 33.00 EGP (8.25/unit) ITRAPEX 100 MG 4 CAPS. MULTI-APEX 38.00 EGP (9.50/unit) SPORANOX 100MG 4 CAPS. JANSSEN CILAG... 42.00 EGP (10.50/unit) 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)