Table 5.

Summary of treatment recommendations for OM in special population groups

Special population	Preferred agent	LOE, GOR
Pediatric (SWO or DLSO without matrix involved)	Efinaconazole, tavaborole >ciclopirox, amorolfine	LOE III, GOR B
Pediatric patients (multiple nails affected, matrix involvement, or PSO)	Terbinafine for dermatophyte OM Itraconazole for NDM Fluconazole for candidal OM	LOE III, GOR B
Geriatric patients	Topical > systemic therapy (if likely to be successful) (Terbinafine > itraconazole)	LOE III, GOR C
Pregnant women	Topical (ciclopirox > amorolfine)	LOE II, GOR B
Lactating	Topical (ciclopirox > amorolfine)	LOE II, GOR B
Diabetic	Topical + oral (terbinafine preferred) + Mechanical measures	LOE III, GOR C
Immunosuppressed	Oral (terbinafine preferred)	LOE V, GOR D
Psoriatic nail	Oral (itraconazole preferred)	LOE V, GOR D
Chronic kidney disease	Topical agents preferred If required, oral itraconazole preferred	LOE V, GOR D
Chronic liver disease	Topical agents preferred	LOE V, GOR D
Cardiac disease	Topical agents preferred If required, oral terbinafine preferred	LOE V, GOR D
Peripheral vascular disease	Same as general population; however, therapy should be prolonged	LOE V, GOR D