Onychomycosis

• do a cx of nail clippings and subungual debris of the affected nail
• 90% will be Trichophyton rubrum
• If the nail lunula is not involved, start with topical therapy: ciclopirox 8% nail lacquer qd for 6 mos. If no effect, consider systemic antifungals: terbinafine is most commonly used, but both itraconazole and fluconazole may be effective
• consider the nail lacquer as ppx as well

Consultant for Pediatricians, May 2006