Recommendations

The Australasian College of Dermatologists

4.
Do not prescribe topical or systemic anti-fungal medication for patients with thickened, distorted toenails unless mycological confirmation of a dermatophyte infection has been obtained.

Fifty percent of thickened distorted toenails are caused by age, pressure from footwear (onychogryphosis) or other trauma, or associated with inflammatory disorders such as psoriasis or lichen planus, and are not due to a fungal infection.

Supporting evidence
  • de Berker D. Fungal nail disease. N Engl J Med 2009;360:2108-16.
  • Ameen M, Lear JT, Madan V, et al. British Association of Dermatologists’ guidelines for the management of onychomycosis 2014;171(5);937-58.
  • Eisman S, Sinclair R. Fungal nail infection: diagnosis and management. BMJ 2014;348:g1800.
How this list was made How this list was made

A long-standing College Fellow, in consultation with the Honorary Secretary has prepared 5 recommendations. All ACD members were invited to choose three out of the five recommendations. Following an NPS Representatives meeting, it was noted that five recommendations are needed. Therefore the remaining two recommendations were selected.