Toenail Changes and Suspected Drug Rash

Lindsay Irwin, BS; Preeya T. Shah, MD; Richard Harold Flowers IV, MD


November 20, 2023

For the medical management of superficial and localized tinea corporis, topical azoles (eg, clotrimazole, ketoconazole) and allylamines (eg, terbinafine, naftifine) can be used to treat the affected area twice daily for 1-6 weeks on the basis of clinical response. Indications for which systemic antifungal therapy may be warranted include but are not limited to tinea capitis and tinea unguium, extensive tinea infection (involving more than one body region simultaneously), and tinea pedis that is extensive or is associated with recurring and troubling blistering. Some of the more commonly prescribed systemic antifungal agents are terbinafine, itraconazole, fluconazole, and griseofulvin. The dosing and duration of the treatment course vary, although the duration may range from 1 to 8 weeks depending on the agent selected and the degree of disease involvement.[8]

With respect to nonpharmacologic measures, patients should be encouraged to wear loose-fitting clothing made of cotton or materials created to wick moisture away from the surface. Patients should also be advised to avoid walking barefoot or sharing garments and be counseled on good skin care measures, such as regular bathing and complete drying of the skin after washing, as well as the removal of contaminated materials, such as clothing.

Overall, treatment of tinea infections may take several weeks to months for full resolution, which is why patient adherence, medical comorbidities, and extent of disease involvement are all important factors in therapy selection. With respect to this patient's case, he was advised on the nonpharmacologic measures discussed above and oral terbinafine 250 mg once daily for 4 weeks was started. Subsequently, his rash completely resolved.


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