Patient counselling

• patients taking oral antifungals should be reassured that their nail infection may continue to respond even after the course of treatment is completed - this is because itraconazole and terbinafine persist in nail keratin for up to nine months after end of treatment
  
  
• the damaged nail may take much longer than three months to grow out. This is despite the fungi being dead after the antifungal treatment
  
  
• patients should be reminded of good nail hygiene:
  • nails kept short
  • hypertrophic nails should be filed down
  • avoid contact with irritants and trauma
  • avoid the use of the same instruments on both infected and uninfected nails
  • wear shoes with good support, a wide toe box and avoid narrow toe and high heeled shoes
  • feet should be kept cool and dry

Reference

1. Ameen M, Lear JT, Madan V, et al. British Association of Dermatologists' guidelines for the management of onychomycosis 2014. Br J Dermatol. 2014 Nov;171(5):937-58.