Onychomycosis Clinical Considerations and Recommendations

Mickey Hart, PharmD Candidate 2015; Lynne Fehrenbacher, PharmD, BCPS-AQ ID


US Pharmacist 

In This Article

Abstract and Introduction


Onychomycosis (fungal infection of the nail) is a common dermatologic condition. Despite often being thought of as a purely cosmetic issue, it may be a source of morbidity and thus warrants treatment. Pharmacists, as highly accessible healthcare professionals, are able to play an important role in the prevention and treatment of onychomycosis. This article summarizes the prevalence, risk factors, prevention, diagnosis, and nonpharmacologic treatment of onychomycosis and also provides a review of available pharmacotherapy options.


Onychomycosis is a fungal infection of the nail apparatus that is caused by dermatophytes, most often Trichophyton rubrum, or nondermatophyte molds and yeasts, most often Candida species.[1] It is a common dermatologic condition; prevalence in the general population in North America is estimated to be 7% to 15%, with about 90% of cases involving the toenails.[1–3] Although some practitioners continue to view onychomycosis as a purely cosmetic issue, serious complications such as cellulitis can occur, particularly among patients with risk factors such as diabetes and peripheral vascular disease.[1] Even patients at low risk for complications often report reduced quality of life; therefore, treatment should be considered whenever possible.[1] Both topical and oral antifungal agents are available to treat onychomycosis, and it is important that pharmacists be aware of the efficacy, tolerability, and appropriate treatment duration of each antifungal.