table of contents
Diagnostic Protocol
- Initial Microscopic Examination
- Perform potassium hydroxide (KOH) preparation or fungal culture
- Objective: Confirm presence of fungal elements (hyphae/spores)
Treatment Pathways
A. Fungal Infection Confirmed (Onychomycosis)
1. Systemic Antifungal Therapy
| Medication | Dosage Regimen | Duration |
|---|---|---|
| Itraconazole | 200mg daily | 12 weeks |
| Terbinafine | 250mg daily | 12 weeks |
2. Topical Adjuvant Therapy
- Amorolfine 5% nail lacquer
- Application: Weekly after nail filing
- Coverage: Entire affected nail plate + 5mm peripheral skin
3. Monitoring Protocol
- Liver function tests (baseline and monthly)
- Clinical reassessment at 4-week intervals
B. Non-Fungal Etiology (White Nail Syndrome)
1. Diagnostic Workup
- Serum trace element panel:
Zinc ✔️ Iron ✔️ Selenium ✔️ Calcium
2. Therapeutic Interventions
-
Nutritional Supplementation:
- Zinc sulfate: 220mg twice daily
- Ferrous sulfate: 325mg daily (if iron deficient)
-
Topical Therapy:
- Urea 40% cream: Apply under occlusion nightly
3. Follow-Up Schedule
- Repeat trace element testing at 6 weeks
- Nail plate photography for progress documentation
Key Clinical Notes
- Combination therapy (oral + topical) improves mycological cure rates by 28% vs monotherapy
- Nail avulsion contraindicated in white nail syndrome
- Consider onychoscopy for refractory cases
Treatment response typically visible within 8-12 weeks. Full nail regrowth requires 9-18 months.