skip to main content

Onychomycosis — SCE Dermatology MCQ

Instant feedback + full explanation. One question, done properly.

EasyNail DisordersOnychomycosisSCE Dermatology

A 50-year-old man presents with thick yellow discolouration and onycholysis of multiple toenails. KOH preparation and culture confirm Trichophyton rubrum. He has failed topical amorolfine nail lacquer after 6 months. What is the most appropriate oral treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Terbinafine 250 mg daily for 12 weeks

Oral Terbinafine 250 mg daily for 12 weeks (toenails) is the first-line oral antifungal for dermatophyte onychomycosis, with the highest mycological cure rates (approximately 76%). BAD guidelines recommend Terbinafine over Itraconazole for dermatophyte nail infections. Itraconazole pulse therapy is an alternative. Griseofulvin requires very prolonged courses and has lower efficacy. Ketoconazole is no longer recommended orally due to hepatotoxicity risk. LFTs should be checked at baseline and during treatment.

Reference: BAD 2014 Guidelines for management of onychomycosis