Derm question

[Dr. Gangrene]

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Going to be a pod, I am obviously inclined to see a pod for foot issues.
That being said, here is my question.

Who usually would better diagnos fungal foot infections, a pod or Dermatologist?
A friend asked me about some growth he has going on (obviously, since I am accepted into pod school I all ready know it all ).

His issue is this: In his opinion, a foot specialist would be the best to see. However, his insurance won't cover a pod unless he is referred.

So, who has more experience in derm foot issues? (usually).

 

[FeetforLife]

I've been working at a dermatologist for quite some time now and have had several patients come in for fungal infections on the foot....both skin and toenails. The way the derms do it is they take scrapings/clippings to be sent to pathology (fungal culture/pas stain). They are treated depending on the type of infection....MD might prescribe a topical or oral....or even wait for the path report first.

I guess it all depends on insurance....the practice I work at is PPO so they self refer. I'm not sure how the podiatrists treat fungal cases (just turned in my application to pod schools!)....but this post caught my eye since I was actually curious if there was a different approach.

One thing I see is a lot of rejections from drug companies for Lamisil. I see these old patients that have had toenail fungus for YEARS and still get denied since it is considered cosmetic. poor things 🙁

Well there's my input if it helps 🙂

 

[Dr_Feelgood]

Going to be a pod, I am obviously inclined to see a pod for foot issues.
That being said, here is my question.

Who usually would better diagnos fungal foot infections, a pod or Dermatologist?
A friend asked me about some growth he has going on (obviously, since I am accepted into pod school I all ready know it all ).

His issue is this: In his opinion, a foot specialist would be the best to see. However, his insurance won't cover a pod unless he is referred.

So, who has more experience in derm foot issues? (usually).

Many insurance companies also require a referral for derms. I would dare to say they both see a ton of fungus. The treatment can be the same, but I do not see a derm wanting to debride nails in the long term. So they might even send patients to a pod after an initial consultation.

 

[krabmas]

Going to be a pod, I am obviously inclined to see a pod for foot issues.
That being said, here is my question.

Who usually would better diagnos fungal foot infections, a pod or Dermatologist?
A friend asked me about some growth he has going on (obviously, since I am accepted into pod school I all ready know it all ).

His issue is this: In his opinion, a foot specialist would be the best to see. However, his insurance won't cover a pod unless he is referred.

So, who has more experience in derm foot issues? (usually).

I think this depends on the pod and the derm. Some pods do not want to look at fungus and nails so you will not get the best treatment from them.

As jonwill (I think) said derms do not debride the nails. for lamisil to work well pods believe that debridement of the nail assists in lamisil treatment (there is an article on this somewhere).

Derms are more into determining the root cause of the fungal infection - yeast, t. rubrum, t. mentigriphytes....? - then treating it based on etiology. pods typically have a treatment plan that typically works so they try it and if it doesn't work then they start thinking about cultures and re-thinking the treatment plan. The reason for waiting to take cultures is that it can take a couple weeks to grow and classify your fungus so if treatment can be started and works with out the culture why not. If the insurance company requires a culture or KOH or PAS then the pod will do that first.

Fungus is really tricky to treat. So whomever you go to it will not be a one time quick fix.

Today someone told me that Castle soap from trader joes is good for fungus. It is pepermint soap. I've told many a patient to use Vick's vapor rub to soften the nails. This sometimes has a slight antifungal effect. So I am starting to think that if we just dump menthol on our patients nails maybe this will work.

 

[Dr_Feelgood]

As jonwill (I think) said derms do not debride the nails. for lamisil to work well pods believe that debridement of the nail assists in lamisil treatment (there is an article on this somewhere).

Jonwill, Jonwill. Didn't you see the cowbell???

I belive it is the IRON CLAD study(Lamisil and Debridement) but I might be wrong.

 

[krabmas]

Jonwill, Jonwill. Didn't you see the cowbell???

I belive it is the IRON CLAD study(Lamisil and Debridement) but I might be wrong.

What does IRON CLAD stand for? We actually had a test question asking this.

what is the cowbell statement about?

 

[Dr. Gangrene]

👍

I think this depends on the pod and the derm. Some pods do not want to look at fungus and nails so you will not get the best treatment from them.

As jonwill (I think) said derms do not debride the nails. for lamisil to work well pods believe that debridement of the nail assists in lamisil treatment (there is an article on this somewhere).

Derms are more into determining the root cause of the fungal infection - yeast, t. rubrum, t. mentigriphytes....? - then treating it based on etiology. pods typically have a treatment plan that typically works so they try it and if it doesn't work then they start thinking about cultures and re-thinking the treatment plan. The reason for waiting to take cultures is that it can take a couple weeks to grow and classify your fungus so if treatment can be started and works with out the culture why not. If the insurance company requires a culture or KOH or PAS then the pod will do that first.

Fungus is really tricky to treat. So whomever you go to it will not be a one time quick fix.

Today someone told me that Castle soap from trader joes is good for fungus. It is pepermint soap. I've told many a patient to use Vick's vapor rub to soften the nails. This sometimes has a slight antifungal effect. So I am starting to think that if we just dump menthol on our patients nails maybe this will work.

My friend has a growth on the SKIN. Do pods only deal w/ toenails? This is not a toenail thing, it is tinea pedis or some other cutaneous fungal infection.

Thanks for the info on the nails though 👍

 

[Feli]

Well, this is beginning to borderline on an advice seeking thread, but I'd skip seeing anyone for now. Tell him to go to Walgreens and pick up some OTC treatment and give that a try first (I can't really recommend an ingredient/vehicle in the open forum because it's against the rules). Most cutaneous tinea are gonna respond to the same stuff, though.

If it's a simple case, any FP doc at the campus health center can treat it (and that's why your insurance won't pay for a specialist who costs twice the $ without the FP doc deeming the patient as needing a specialist referral). If it's recalcitrant to conventional therapy, then, yeah, you will probably need a pod or derm referral and a culture/KOH/PAS/etc.

 

[krabmas]

👍

My friend has a growth on the SKIN. Do pods only deal w/ toenails? This is not a toenail thing, it is tinea pedis or some other cutaneous fungal infection.

Thanks for the info on the nails though 👍

How do you know the growth is fungal? Many things apear on the skin that look like fungus and are not. Can you describe the lesion or do you have a picture?

 

[Dr. Gangrene]

How do you know the growth is fungal? Many things apear on the skin that look like fungus and are not. Can you describe the lesion or do you have a picture?

You are right, I do not know if it was fungal. I think I let my exapmle take over the thread. My point was to see if a dpm looks at cutaneous skin problems, or just nail problems. Thanks for all of the info👍

p.s. he all ready went in to a derm, and got an ointment. damn insurance companiesb

 

[Dr. Gangrene]

Well, this is beginning to borderline on an advice seeking thread, but I'd skip seeing anyone for now. Tell him to go to Walgreens and pick up some OTC treatment and give that a try first (I can't really recommend an ingredient/vehicle in the open forum because it's against the rules). Most cutaneous tinea are gonna respond to the same stuff, though.

If it's a simple case, any FP doc at the campus health center can treat it (and that's why your insurance won't pay for a specialist who costs twice the $ without the FP doc deeming the patient as needing a specialist referral). If it's recalcitrant to conventional therapy, then, yeah, you will probably need a pod or derm referral and a culture/KOH/PAS/etc.

That was not the point of the thread. I was just using an example to illustrate my question. My point was to see how much cutaneous derm a dpm deals w. thanks for the reply.

 

[krabmas]

You are right, I do not know if it was fungal. I think I let my exapmle take over the thread. My point was to see if a dpm looks at cutaneous skin problems, or just nail problems. Thanks for all of the info👍

p.s. he all ready went in to a derm, and got an ointment. damn insurance companiesb

For cutaneous derm stuff, yes pods learn to diagnose and treat derm of the feet.

The difference between what a derm does and what I have learned so far from DPMs is...

If it looks like tinea (but unsure) the general pod tries fungal creams.

The derm might try steroid cream first.

There are pods out there that specialized in podiatric dermatology like Dr. Bryan Markinson at MSSM and Dr. Brad Bakotic that treat the skin of the feet like a derm MD would.

 

[whiskers]

Going to be a pod, I am obviously inclined to see a pod for foot issues.
That being said, here is my question.

Who usually would better diagnos fungal foot infections, a pod or Dermatologist?
A friend asked me about some growth he has going on (obviously, since I am accepted into pod school I all ready know it all ).

His issue is this: In his opinion, a foot specialist would be the best to see. However, his insurance won't cover a pod unless he is referred.

So, who has more experience in derm foot issues? (usually).

It depends on who can see better and has a better woods lantern lol

Other than that I dare say that they both are decent options. Probably a longer wait to see the derm.

 

[gsrimport]

If it's really suspicious, a sample might be taken and sent to the lab. I just rotated through a pod who took a small sample off the targeted area. Depending on the lab results, the patient might be referred to another specialist.

I think pods are great at what they do but they do consult others (infectious disease doc, dermatologist) and refer them for the benefit of the patient.

 

[narkotiks]

If it's really suspicious, a sample might be taken and sent to the lab. I just rotated through a pod who took a small sample off the targeted area. Depending on the lab results, the patient might be referred to another specialist.

I think pods are great at what they do but they do consult others (infectious disease doc, dermatologist) and refer them for the benefit of the patient.

correct. why wouldn't a pod do this? specialization is very important and if there is a more qualified individual who knows more about specific problems, that individual should be brought into the situation.

 

[WildcatDMD]

nevermind