Fungal nail infection (onychomycosis) can involve the nail plate, nail bed, and/or the root of the nail. It affects toenails more frequently than fingernails. It evolves slowly, causing discolouration of the nail unit, distortion of the nail plate, and thickening of the nail bed and adjacent tissue.

Causative organisms are dermatophyte and non-dermatophyte moulds, and yeasts such as candida. Dermatophyte moulds are responsible for most cases.

Amorolfine 5 per cent lacquer

Amorolfine has a broad spectrum of activity, including dermatophytes, other fungi and yeasts. The nail lacquer formulation builds a non-water-soluble film on the nail plate, which remains there for a week and acts as a depot for the drug.

Continuous use for a minimum of six months is usually required. Minor adverse reactions are very rare, mainly a slight burning sensation and irritation. Amorolfine is not systemically absorbed and there are no interactions with other drugs.

Amorolfine 5 per cent nail lacquer is licensed for treatment of mild cases of the most common and easily recognised types – distal and lateral – of onychomycosis, affecting up to two nails, in adults from 18 years of age. It is not licensed for sale in pregnancy or breastfeeding, or if a patient has any underlying conditions predisposing to fungal nail infections, such as peripheral circulatory disorders, diabetes mellitus, or if the patient is immunocompromised or immunosuppressed. It should not be supplied if there is nail dystrophy or the nail plate is destroyed.

The lacquer should be applied once weekly. The pack size is 3ml – sufficient for about three months’ use, after which progress should be reviewed. Treatment should be continued until the infected section of nail has completely grown out, which takes about six months for fingernails and nine to 12 months for toenails.