What are the recommended first-line treatments for onychomycosis in adults according to current UK guidelines?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

For adults with confirmed dermatophyte onychomycosis, the recommended first-line treatment is oral terbinafine 250 mg once daily for 6 weeks for fingernails and 12-24 weeks for toenails, with visible improvement typically seen after 2 months of fingernail treatment and 3 months of toenail treatment .

In cases of confirmed Candida or non-dermatophyte nail infection, first-line treatment is oral itraconazole, administered as pulsed therapy of 200 mg twice daily for 1 week, with subsequent courses repeated after 21 days, for 2 pulses for fingernails and 3 pulses for toenails .

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