Volume 17 - Issue -
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
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
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
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