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Dermatology2 papers

Onychomycosis of toenails

Last edited: 4/10/2026

Overview

Onychomycosis is a fungal infection affecting the fingernails and toenails 1. In Europe, dermatophytes are the primary causative agents of tinea unguium 1.

Diagnosis

  • Diagnostic workup includes microscopic examination, culture, and/or molecular testing of nail scrapings 1.
  • Management

  • For mild or moderate nail infections, topical treatment with antifungal nail polish is recommended 1.
  • For moderate to severe onychomycosis, oral treatment is recommended in the absence of contraindications 1.
  • Treatment should incorporate both topical and systemic agents 1.
  • Key Recommendations

  • For mild or moderate onychomycosis, local treatment with antifungal nail polish is recommended 1. (Evidence: Expert opinion)
  • In cases of moderate to severe onychomycosis, oral treatment is recommended, provided there are no contraindications 1. (Evidence: Expert opinion)
  • Treatment regimens should include both topical and systemic antifungal agents 1. (Evidence: Expert opinion)
  • References

    1 Nenoff P, Reinel D, Mayser P, Abeck D, Bezold G, Bosshard PP et al.. S1 Guideline onychomycosis. Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG 2023. link

    Original source

    1. [1]
      S1 Guideline onychomycosis.Nenoff P, Reinel D, Mayser P, Abeck D, Bezold G, Bosshard PP et al. Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG (2023)

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