Members do not see these Ads. Sign Up.

Hi all,

What is the current opinion regarding surgical treatment (total nail avulsion without phenolisation) + topical anti-fungal of onychomycosis WITHOUT conformation via microscopy or culture?

Cheers,

FD.

 

I've done this once before.

Unilateral OM affecting the L1st. Obviously mycotic as it was thick, yellow crumbly and had the tell tale odour. The nail was already really quite loose, only really tethered at the PNF. The remaining nails were all perfectly healthy.

Organised both topical and systemic treatments via the GP then did a TNA without phenol. Advised the chap to apply the lacquer to the exposed nail bed.

Trouble is I haven't seen him since initial assessment so don't know how he got on. I would be very suprised if what we did had no positive effect though.

It's a bit belt and braces but seems a reasonable way to proceed to me, might as well just get it sorted!

 

I often have this discussion about microscopy/culture as most UK GPs require a positive result before prescribing oral terbinafine.

It is frustrating when usually if you're recommending someone takes this you are pretty sure about the dx.

Likewise if you're considering TNA without phenol I'm presuming it's because everything in presentation and history points to O/M and theres no suggestion it could be anything else. In which case what would be the value of doing microscopy/culture anyway?

Ian

 

I would suggest one way would be to use 10% urea cream to avulse the nail.
the nail bed can then be treated with topical antimycotics, and the nail will regrow without any damage.

this is particularly useful in the 'at risk' patient. I have used this v ery successfully in Diabetic patients.