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Recommendation for Onychomycosis prophylaxis, post nail avulsion ?

Discussion in 'General Issues and Discussion Forum' started by kbarb, Jan 26, 2023.

  1. kbarb

    kbarb Welcome New Poster

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    Anyone have a recommendation for an ongoing prophylaxis regimen, to prevent onychomycosis re-infection ?
    This is after I chemically debrided / avulsed 3 toenails with Farber's urea based avulsion poultice (more details below).

    A quick history :

    • ~100% infected toenails, all 10 toenails
    • Terbinafine oral treatment
    • Nail avulsion poultice using Dr. Eugene Farber's recipe, to remove dystrophic nail areas. (Dr. Farber, deceased, was Chair of Stanford Med. Derm)
    • Result : 10 clear nails, for 10+ years
    2022 - 2023
    • Got reinfected on 3 toes, 70% distal, but not into the matrix.
    • January ‘23 : applied Dr. Farber's nail avulsion poultice on the 3 toes
    • - Success: 3 toe's nails avulsed (except for uninfected proximal 10-30% nail); no issues
    My question :

    Now, while the nails are growing back in, and in perpetuity : How would you prophylactically treat the nails to prevent re-infection ? I’m obviously vulnerable.
    What I have access to :
    • Terbinafine drops/liquid - every day / once a week / other ?
    • Clotrimazole cream - every day / once a week / other ?
    • Alcohol - every day / once a week / other ?
    • Other ?

    Reference :
    • "Urea Ointment in the Nonsurgical Avulsion of Nail Dystrophies" - Cutis Journal,1980 Jun;25(6):609-12.
    • (and I have the recipe and poultice bandaging/wrapping directions if anyone wants them)
  2. William Fowler

    William Fowler Active Member

    I don't think there is any definitive or standardized advice on this.

    I assume the best way would just be good foot hygiene practices and periodic application of a topical anti-fungal - I not sure which one would be better. As its for prevention,m a cheaper one?

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