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Onychomycosis treatment - nail removal plus . . .

Discussion in 'General Issues and Discussion Forum' started by runlong, Sep 4, 2014.

  1. runlong

    runlong Welcome New Poster

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    This inquiry is regarding a curative treatment for onchomycosis. There are many 'DIY' and advertised treatments. Due to paid ads and marketing hype and financial motives for treatment it is difficult to determine a simple and effective treatment. In my opinion, I doubt one should require lasers or toxic chemotherapeutic agents for a year to treat a nail infection. I also have doubts as to whether there is really an effective treatment in the form of a topical regimine, if for no other reason than the fact that one is not going to perform a treatment daily or twice daily for over a year.

    I'm looking specifically to what sort of topical chemical treatment would be most effective when applied after an onchomycotic nail has been entirely removed, a first toe nail, to take a worst case.

    What medication or medication combo would work best for such treatment and for how long? I'm guessing that treating a nail bed without the nail should greatly improve cure rate and reduce the treatment time and the need for systemic treatment.

    My background is as a medical doctor, but not foot or bone related.

    Regards . . .
  2. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    My personal views after treating (or trying to..) many thousands of cases of onychomycosis in tropical and subtropical climates;

    * fungal spores are the most difficult pathogenic organisms to kill
    * all infections proximal to the eponychium will not respond to topical therapies
    * almost all topical therapies applied directly to infected mycotic nails fail, unless the gross area of infected nail tissue is grossly excised - and well distal to the eponychium. Even then, they usually fail, or only provide temporary clinical improvement - rather than mycological cure.
    * the greatest cure rate that I have experienced is with oral terbinafine - anecdotally approaches 90%. Treatment times vary from 12--16 weeks.
    * I believe the risk of hepatic side effects from oral terbinafine to be overemphasised. I've not had any patient ever have to discontinue (oral) treatment due to actually any side effect.
    * I have done a few nail plate avulsions followed by by topical terbinafine. Success rates would be around 40-50% at best. If the infection has already ascended proximal to the eponychium, then the nail matrix is assumed to also carry infection. Unlikely that avulsion followed by topical therapies will work.
    * I have no direct experience with laser therapy. But I do see lots of patients who have had this therapy, and gained no improvement.
    * most patients have concurrent moccasin tinea pedis is more than 3 nails are affected
    * the great toe has by far the highest incidence (?80-90%). No one can explain why to me.

    Just my experiences. Already seen 2 or 3 cases this morning...

  3. runlong

    runlong Welcome New Poster

    Thanks, LL for the accounts of personal experience!

    Wondering if avulsion plus a brief round of oral terbinafine plus the topical would be a good compromise?

    What sort of topical terbinafine preparation have you used?
  4. MJJ

    MJJ Active Member

    I have also found nail avulsions followed by topicals to be ineffective.

    *edit* Unless of course the topical that you are applying is phenol.......works like a charm ;-)
    Last edited: Sep 5, 2014

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