How important is debridement in onychomycosis?

Indeed. I blame those pesky anti-microbial peptides. You`s either got them, or you`s don`t.

 

maybe this will help with the pesky peptides ....

 

Back to the importance of debridement in onychomicosis. If you debride the infected portion of the nail, how do you prevent the nail fold from occupying the space, resulting in an ingrown nail as shown in photos #2 and #3 in this post: http://www.podiatry-arena.com/podiatry-forum/showpost.php?p=163227&postcount=175?

Believe me, it's painful because I am now in the same position as photo #2 - a clear nail but now excrutiating pain in the toe. I know the nail could be debrided again to look like photo #3 but wouldn't the nail grow into the fold again?

 

Currently I am treating him palliatively for his involuted nail, which is his default nail state. Typically his nail margin is reduced wihththe use of a SM 15 or 67 and any debris removed. He is not keen on a pna and seeing as it is his toe, his choice, although he is very happy at the condition of his previously pungent decaying nail.

 

Hi all just to add to the onychomycosis debate- i tend to use debridement as far as possible of the affected nail, then i get the patient to file accross the nail plate thats left daily and to apply 2 drops of neat tea tree oil to this area. patient returns to me 4-6 weekly untill the nail plate has grown back usually 3-6 months. no nail varnish to be used and go shoe and sockless as much as possible (fungi hate the light), walk in sea water frequently, generally lots of light air and tea tree oil one patient with terrible onychomycosis added prayer to this and successfully got rid of his awfull nails!

 

Corndolly,

Are you aware of the documented reactions to the terpenoids in Tea Tree Oil?.... and I hope you are making your patients aware of the dangers in applying oxidated TTO. You know, you could recommend household bleach as a fungicide....it would work... and result in the same contact dermatitis and paronychia often seen with use of TTO.

Cheers,
Bel

 

Whow! thanks belinda for the tto info, I was not aware. However I have been using this method for almost 20years, in both the uk and ireland and have never had a case of paronchia or contact dermatitis or any side effects at all. I have treated hundreds of patients and the only complaint was from one lady who didnt like the smell. I did some training on aromatherapy years ago where we covered the contraindications for oils and lavender and tea tree were the two which were ok for applying undiluted to the skin. I would like to look at the documented research so could you let me know where these are published. thanks again.

 

From post #38 above:

 

I am really sorry if my experience with Tea Tree oil and onychomycosis bucks the research but if it works then why would I not offer this treatment? Not every patient wants to or can take the usual pharmacutical route which often doesnt work anyway. at the end of the day the patient should be given information about all treatments available and together a treatment plan is drawn up. I am just lucky to have such success without causing any dermatological problems, maybe that is why I get so many referrals from GPs for especially difficult patients!

 

But, it has been shown not to work and has been shown to be dangerous. Good luck trying to defend your actions in a court.

 

Does anyone have any input/information on problems or side effects of aggressive debridement. Iis there a higher incidence of ingrowing or pain post treatment. I do debride when i have compliant patients who are motivated to applying Loceryl or tea tree oil, but if the fungi has invaded the nail borders surely this may lead to OC if debrided? Also I have a local GP surgery that is very reluctant to prescribe oral terbinafine, has anyone else experienced this and how have you dealt with this reluctance.

 

I am interested in the answer to this, too.

 

Just my thoughts on attempting to get a succesful resolution to stubborn mycotic' infections.
1. Ensure positive diagnoses of fungal infection.
2.Aggresive removal of non viable nail.
3.if no contraindications: use of topical nail lacquer: Loceryl and if required 12 week prescription of oral terbinafine.
Key: is patient compliance in use of lacquer/ filing of nail / and in correct taking of oral meds.

review 4/52.

have tried tea tree oil and had some success, Also advised use of Vick chest rub to one young healthy lady on heavily infected nails and this achieved almost a 100% resolution in clearing the fungal nails from both feet - with minimal input from myself. Has anyone else tried 'vick'

 

hi jasper 1966
What is the active ingredient in Vick?

 

Paraffin,Camphor,turpentine,menthol & eucalyptos oil - read an article on the internet as you do - possibly a stateside article.Think it showed some success, so igave it a whirl.not had chance to repeat it but it certainly seemed to work on this occasion.