tinea unguium

[12R34Y]

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all right guys!

what's the latest with treatment and success rates for toenail fungal infections. Especially if caught VERY VERY early and only on one toe?

topicals in/out? oral therapy the best?

just curious.

thanks guys.

 

[jonwill]

all right guys!

what's the latest with treatment and success rates for toenail fungal infections. Especially if caught VERY VERY early and only on one toe?

topicals in/out? oral therapy the best?

just curious.

thanks guys.

That depends on the study you read and how you define success. Some studies define success as a mycologic cure (negative KOH and culture). Others define success as a clinical cure (patient sees nails as being normal again). Still other studies define different criteria. Depending on how you define success, the cure rates generally go from 30-80%.

 

[12R34Y]

That depends on the study you read and how you define success. Some studies define success as a mycologic cure (negative KOH and culture). Others define success as a clinical cure (patient sees nails as being normal again). Still other studies define different criteria. Depending on how you define success, the cure rates generally go from 30-80%.

Agreed. That's why I'm asking the experts for an opinion. I can't seem to get anything in my literature that doesn't have a HUGE range of success. They'll list a treatment and say topicals typically only have a cure rate of 20%, but theres so many treatments to choose from for systemic treatment.

so......i want to know what the pods are doing? they're the experts.

thanks!

 

[krabmas]

if you have a healthy liver try lamisil. That is supposidly the best, but still a range. Some people are just resistant to the meds.

You can also use topicals while on the lamisil - your pick.

 

[12R34Y]

if you have a healthy liver try lamisil. That is supposidly the best, but still a range. Some people are just resistant to the meds.

You can also use topicals while on the lamisil - your pick.

Isn't there both topical lamisil and oral?

 

[12R34Y]

Isn't there both topical lamisil and oral?

what about penlac? any opinions?

 

[dpmgrad]

Isn't there both topical lamisil and oral?

Yes, theres are both oral and topical versions of Lamisil. Topical Lamisil is an OTC drug for tinea pedis. On the other hand, oral Lamisil is a prescriptive medication that is utilize in the treatment for onychomycosis (Tinea Unguium). There is a great deal of variation in terms of success rate with oral Lamisil. The highest rate I have seen in literature has been up to about 70-80% (Novartis quotes 70% cure rate). There are other regimens where DPMs and Dermatologist would combine oral Laimisil with nail debridement and / or some topical nail agent, such as Penlac, Keralac, etc.. to increase the success treatment rate. Besides Lamisil, there is also oral Sporanox. However, the side effect panel and contraindcations for Sporanox are worse as compared to Lamisil. I have also seen some Dermatologists and DPMs used Diflucan as well for onychomycosis. However, I don't know the efficacy rate of Diflucan and whether or not it is off label usage of Diflucan for onychomycosis.

 

[dpmgrad]

what about penlac? any opinions?

Penlac is a topical agent that is usually indicated for mild to moderate onychomycosis. If the toenail is severely infected, the cure rate is very very low with Penlac since the nail is too thick for the medication to penetrate through. The literature states that the average cure rate is about 40-50%. It does vary quite a bit depending on what you read. Many of the DPMs that I have seen usually reserve Penlac for treating mycotic nails in the very early stages. When using Penlac, there are specific instructions in regards to Penlac treatment for mycotic nails besides simply applying the nail lacquer on. If these specific instructions are not followed, this would decrease the efficacy of the Penlac. Unfortunately, Penlac is the only agent approved for onychomycosis in the US. In Europe, there is a second topical agent for onychomycosis called Amorolfine.

 

[12R34Y]

thanks guys!

very helpful info.

later