594 DISEASES/DISORDERS
Surgical excision
Amputation of digit or leg
Chemotherapy and/or radiation therapy. Nail dystrophy:
Treat underlying cause.
Drugs of Choice
Bacterial paronychia: systemic antibiotics based on culture and sensitivity.
Yeast (CandidaorMalassezia) paronychia: ketoconazole 5–10 mg/kg PO BID to q24h
(dogs) or fluconazole 5 mg/kg PO BID (dogs and cats) for 2–4 weeks; topical nystatin,
miconazole, terbinafine.Onychomycosis: ketoconazole 5–10 mg/kg PO BID for 6–12 months until negative
cultures; itraconazole 5–10 mg/kg PO q24h for 3 weeks and then pulse therapy twice
a week until resolved.Onychomadesis: determined by cause; immunomodulation therapy for immune-
mediated diseases; medication options include essential fatty acid supplementation;
cycline antibiotics: tetracycline 250 mg PO TID for dogs<10 kg; 500 mg PO TID dogs
>10 kg); doxycycline 10 mg/kg PO q24h; minocycline 5 mg/kg PO BID; often admin-
istered with niacinamide 250 mg PO for dogs<10 kg and 500 mg PO for dogs>10 kg;
pentoxifylline 10–15 mg/kg PO BID to TID; corticosteroids, and cyclosporine 5 mg/kg
PO q24h; vitamin E; appropriate chemotherapeutic agents (e.g., azathioprine, chlo-
rambucil).Symmetric lupoid onychodystrophy; options include essential fatty acid supplemen-
tation; cycline antibiotics: tetracycline 250 mg PO TID for dogs<10 kg; 500 mg PO
TID dogs>10 kg; doxycycline 10 mg/kg PO q24h; minocycline 5 mg/kg PO BID; often
administered with niacinamide 250 mg PO for dogs<10 kg and 500 mg PO for dogs
>10 kg; pentoxifylline 10–15 mg/kg PO BID to TID; corticosteroids, and cyclosporine
5 mg/kg PO q24h.COMMENTS
Expected Course and Prognosis
Slow claw growth cycle may require 6–8 months of therapy to fully correct an abnor-
mality; improvement may be noted after 6–8 weeks of appropriate treatment.
Bacterial or yeast paronychia and onychomycosis: treatment may be prolonged and
response may be influenced by underlying factors.
Onychorrhexis: may require amputation of the third phalanx for resolution.
Onychomadesis: prognosis determined by underlying cause; immune-mediated dis-
eases and vascular problems carry a more guarded prognosis than do trauma or infec-
tious causes.Nail dystrophy: prognosis is good when underlying cause can be controlled.
Neoplasia: excised by amputation of the digit; malignant tumors may have metasta-
sized by the time of diagnosis.