Volume 17 - Issue -
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.
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
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
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
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
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
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