Fungal nail infection: diagnosis and management

#### Summary points Onychomycosis is the term used for fungal infections of nail. A recent review of population based studies of onychomycosis in Europe and the United States found a mean prevalence of 4.3%.1 Onychomycosis can be a source of pain and discomfort and can impact on patients’ quality of life, with psychosocial and physically detrimental effects.2 Disease of the fingernails can cause impaired or lost tactile function, whereas disease of the toenailscan interfere with walking, exercise, and how shoes fit. Untreated patients can act as source of infection for family members and potentially contaminate communal areas. Infection may be chronic and resistant to treatment, with 16-25% of patients not achieving cure by current treatments.3 No spontaneous clearing is known to occur. This review provides an evidence based overview of the diagnosis and management of onychmoycosis. #### Sources and selection criteria We searched Medline, PubMed, the National Institute for Health and Care Excellence website, and the Cochrane Libraryfor systematic reviews, meta-analyses, randomised and non-randomised controlled clinical trials, and case series and reports using the search words “fungal nail disease/infection”, “ tinea unguium”, and “onychomycosis”. We also consulted recent guidelines submitted for publication by the British Association of Dermatologists. Onychomycosis …