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Despite the common prevalence of onychomycosis, there is still a tendency among patients and physicians not to take it as seriously as they should. However, onychomycosis is a progressive, recurring infection that may lead to serious complications, particularly among patients with diabetes, who are approximately three times more likely to have onychomycosis.

With this in mind, a roundtable meeting of expert panelists was recently convened in Philadelphia. I had the pleasure of moderating this roundtable.

Initially, we discussed emerging statistics that reflect the large disparity between those who have the infection and those who have formally been diagnosed. There also appears to be a disturbing gap between diagnosis and treatment. We also reviewed the epidemiology of onychomycosis and discussed the likelihood of the infection’s increasing prevalence, given the aging of the population and the growing number of people who have diabetes.

The panelists discussed the various treatment options for onychomycosis. There was a consensus of opinion that this infection needs to have a long-term management plan in order to help reduce the risk of recurrence. Emerging evidence suggests that combining ciclopirox nail lacquer and terbinafine may not only have a positive clinical effect, but facilitates safer, more cost-effective treatment as well.

Throughout the roundtable, we discussed the importance of patient education and the panelists shared their approaches to managing patient expectations.

I would like to thank the panelists for their participation and Dermik Laboratories for its support of this forum. Hopefully, the insights from this discussion will facilitate improved recognition of this condition as a progressive infection that needs to be treated.


Warren S. Joseph, DPM

Dr. Joseph is a Consultant in lower extremity infectious diseases and is a Fellow of the Infectious Diseases Society of America. He is an Attending Podiatrist at the Coatesville Veterans Affairs Medical Center in Coatesville, Pa.

David G. Armstrong, DPM, MSc, PhD

Dr. Armstrong is a Professor of Surgery, Chair of Research and Assistant Dean at the William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine in Chicago. He is a member of the National Board of Directors of the American Diabetes Association.

Hector Cervantes, DPM

Dr. Cervantes is in private practice in San Jose, Calif.

Scot Malay, DPM

Dr. Malay is in private practice at the Ankle and Foot Medical Centers of the Delaware Valley. He is the Director of Podiatric Research at the University Of Pennsylvania Medical Center-Presbyterian, and is a Fellow of the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania.

Kenneth F. Malkin, DPM

Dr. Malkin is a Fellow of the American Board of Quality Assurance and Utilization Review Physicians. He is a Fellow and the immediate Past President of the American College of Podiatric Medical Review. He is a Fellow of the American College of Foot and Ankle Orthopedics and Medicine, and has a private practice in Caldwell, N.J.

John Mozena, DPM

Dr. Mozena is board certified in foot and ankle surgery and is a Fellow of the American College of Foot and Ankle Surgeons. He is in private practice in Portland, Ore.

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