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  • Jeff Hall, Executive Editor/VP-Special Projects, Podiatry Today
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  • | Volume 17 - Issue
    Here is a view of interdigital tinea pedis. As Dr. Joseph points out, onychomycosis initially starts as tinea pedis and proceeds to get under the toenails. He says it’s important to manage both conditions as they are “inexorably linked.” (Photo courtesy o

    8,277 reads | 0 comments | 09/03/08
    Dr. Joseph: The fact that onychomycosis is an infection is often overlooked. It is a fungal infection of the nail and the nail bed stratum corneum. There is no other infection anywhere on the body that we think twice about treating, but for some reason, this is an infection that we’ve always been reluctant to treat. Just to give you an example, one of my kids came home once with a case of ringworm on his arm. The school nurse sent a note saying that he was not going to be allowed back in school unless he had a note from the doctor saying the ringworm of his arm was under active trea... continue reading
    Here one can see severe onychomycosis. Drs. Joseph and Malkin note that a recent study by Aditya Gupta, MD, PhD, showed that combining ciclopirox and terbinafine for severe onychomycosis results in a faster rate of mycological clearing than either therapy

    8,180 reads | 0 comments | 09/03/08
    Dr. Mozena: When I present my treatment plan for onychomycosis to the patient, I always present a step-wise progression with six different options. We can ignore it, debride it, provide surgical treatment, use topical medications, use oral medications or employ combination therapy. The first option is ignore it. What are the consequences of ignoring onychomycosis? Well, obviously, there are psychological concerns and there are pain issues to consider. Onychomycosis is not only contagious to ourselves, it’s contagious to others. The second option is debridement. When we talk about... continue reading
    “If there are more risks than benefits in using an oral medication for a particular patient, we should consider a topical.”   

— Dr. Cervantes

    6,107 reads | 0 comments | 09/03/08
    Dr. Armstrong: Diabetes is becoming far more common both in the developed and the developing world. By the year 2025, there will be at least 300 million people worldwide with diabetes. People are living longer with diabetes thanks to many advances in diabetes care and improvement in care by primary, secondary and tertiary care physicians. They are also living longer with complications and one of the most significant complications in diabetes is the diabetic foot. We know the most common reason for hospitalization among people with diabetes is not for high blood sugar or a stroke or a h... continue reading
    Dr. Malkin says it’s “important to convey to patients that onychomycosis (as shown above) is not a consequence of aging. It’s an infection.” (Photo courtesy of Aditya Gupta, MD, PhD)

    3,523 reads | 0 comments | 09/03/08
    Dr. Cervantes: Obviously, there is a lot of data and clinical experience in dealing with onychomycosis, but I think the key is educating the patient. You can provide the best medications, whether they are topicals or oral drugs, to the patient but if he or she doesn’t know the medication works or doesn’t get involved with the treatment, the treatment will fail. I definitely believe spending an extra few minutes with the patient will facilitate a better outcome. Patients must understand that onychomycosis is an infection so this is a legitimate threat. We must emphasize the risks a... continue reading
    “A 2002 study found the onychomycosis relapse rate ranged from 50 to 55 percent.” 
— Dr. Malay

    1,494 reads | 0 comments | 09/03/08
    Dr. Malay: Various studies have reported relapse rates of onychomycosis. The Tosti study from 1998 showed a 22 percent relapse after three years.5 In the Heikkila and Stubb study from 2002, they showed the relapse rate being as high as 66 percent.6 There was also information from Jansen, et. al., in PharmacoEconomics in 2001 that showed a 53 percent relapse rate for onychomycosis.22 In a 2002 study published in Archives of Dermatology, Sigurgeirsson, et. al., found that the relapse rate was in the range of 50 to 55 percent. So it’s certai... continue reading
    Here one can see 100 percent relapse of onychomycosis 18 months after a course of terbinafine. Prevention of relapse medication had been discontinued when the patient became pregnant. (Photo courtesy of Kenneth Malkin, DPM)

    2,257 reads | 0 comments | 09/03/08
    Dr. Malkin: The first case I will present centers around a 36-year-old female with a non-contributory medical history who presented with a totally dystrophic isolated hallux nail that had 100 percent involvement. I treated this patient with oral medication and at one point, she had approximately 75 percent proximal clearing of the nail. Then the patient became pregnant and could not use any topicals or orals at all. She came back about 18 months later with 100 percent relapse of her nail. This case illustrates how fast onychomycosis can either recur or relapse. In this case, I feel ... continue reading

    1,186 reads | 0 comments | 09/03/08
    1. Drake LA, Scher RK, Smith EB, Faich GA, Smith SL, Hong JJ, Stiller MJ. Effect of onychomycosis on quality of life. J Am Acad Dermatol. 1998 May;38(5 Pt 1):702-4. 2. Scott-Levin PDDA. November 2003. 3. Zaias N, Battistini F, Gomez-Urcuyo F, et. al. Cutis 1978;22:197-199. 4. Stedman’s Medical Dictionary, 27th ed. Lippincott, Williams and Wilkins, 2000. 5. Tosti A, Piraccini BM, Stinchi C, Colombo MD, Relapses of onychomycosis after successful treatment with systemic antifungals: a three-year follow-up. Dermatology 1998;162-66. 6. Heikkila H, Stubb S... continue reading

    3,094 reads | 0 comments | 09/03/08
    Panelists 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. ... continue reading