Choosing Wisely:

Don’t prescribe oral antifungal therapy for suspected nail fungus without confirmation of fungal infection.

Rationale and Comments: About half of nails with suspected fungus do not have a fungal infection. Because other nail conditions, such as nail dystrophies, may look similar in appearance, it is important to ensure accurate diagnosis of nail disease before beginning treatment. By confirming a fungal infection, patients are not inappropriately at risk for the side effects of antifungal therapy, and nail disease is correctly treated.
Sponsoring Organizations:
  • American Academy of Dermatology
  • Sources:
  • Expert consensus
  • Disciplines:
  • Dermatologic
  • References: • Roberts DT, Taylor WD, Boyle J; British Association of Dermatologists. Guidelines for treatment of onychomycosis. Br J Dermatol. 2003 Mar;148(3):402-10.
    • Mehregan DR, Gee SL. The cost effectiveness of testing for onychomycosis versus empiric treatment of onychodystrophies with oral antifungal agents. Cutis. 1999 Dec;64(6):407-10.

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