A male patient appears with a rash on his fingernails. The rash began months ago and the patient is currently taking Metformin, sertaline, metoprolol and atorvastatin. The patient is not immunocompromised and has no known allergies. The rash has never come before and thinks it may be due to an injury. There have been no recent injuries or associated symptoms, infections or changes in its appearance.
Primary Care Provider's Question
I think this is likely a fungal infection, but I'm seeking a treatment plan given their medications
Our Dermatology Provider's Response
Thank you for your consult. Based on the reviewed photos and history, it appears your patient has onychomycosis, which is a fungal nail infection. A chronic paronychia (which is an inflammation of the nail folds) is possible as well, as sometimes a chronic paronychia can lead to a fungal nail infection. The best treatment is a 6 week course of oral terbinafine (250mg/day). This would have an interaction with his metoprolol so it may require dose adjustment for that medication. Alternatively you can use 8% ciclopirox nail lacquer. If symptoms persist despite treatment then I would treat for a chronic paronychia with fluocinonide ointment twice a day for 2-4 weeks. It is also important to avoid prolonged exposure to water which can worsen this. It takes 6 months for a fingernail to fully replace itself, but the new growth should look normal. Hope that helps!
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