The Australasian College of Dermatologists

Recommendations from the Australasian College of Dermatologists on leg cellulitis, epidermal cysts, urticaria, distorted toenails & acne, advice on systemic non-sedating antihistamines and topical corticosteroids for skin conditions. The Australasian College of Dermatologists (ACD) is the sole medical college accredited by the Australian Medical Council for the training and continuing professional development of medical practitioners in the specialty of dermatology. As the national peak membership organisation, we represent over 550 dermatologist Fellows (FACD) and 100 trainees. We are the leading authority in Australia for dermatology, providing information, advocacy and advice to patients, communities, government and other stakeholders on skin health and dermatological practice.

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.

Date reviewed: 31 March 2021

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.
  • Ghannoum M, Mukherjee P, Isham N, Markinson B, Rosso JD, Leal L. 2018. Examining the importance of laboratory and diagnostic testing when treating and diagnosing onychomycosis. Int J Dermatol. 2018 Feb;57(2):131-138.   (Fee for access)
  • Lipner SR and Scher RK. 2019. Onychomycosis: Clinical Overview and Diagnosis. J Am Acad Dermatol. 2019 Apr;80(4):835-851. (Fee for access)
  • Saunte DML, Piraccini BM, Sergeev AY et al. 2019. A Survey Among Dermatologists: Diagnostics of Superficial Fungal Infections – What is Used and What is Needed to Initiate Therapy and Assess Efficacy? J Eur Acad Dermatol Venereol. 2019 Feb;33(2):421-427. (Fee for access)
How this list was made How this list was made

College’s Expert Advisory Committee, comprising seven longstanding Fellows considered four potential recommendations, together with supporting evidence, and agreed to proceed with three of them. The Committee then refined and finalised the recommendations. These were reviewed by the NPS Representatives Committee and finalised in response to the feedback received.

Download ACD Recommendations