Keys To Managing Severe Onychomycosis

Author(s): 
Myron Bodman, DPM

   Gupta and Simpson report that device-based therapeutic options for onychomycosis are expanding more rapidly than pharmacotherapy. Photodynamic therapy, iontophoresis and laser therapy have shown positive initial results, but randomized controlled trials are necessary to determine the long-term success of any of these devices.42

In Conclusion

Despite the advances in oral, topical and now device-based therapies, manual and electric debridement remains the most commonly employed treatments for severe onychomycosis.43 Better benchmarks for clinical success may be improved with quality of life surveys and reduction in validated severity scores. These measurements may be more relevant to patients than complete mycological cures for a typically chronic and recurrent disease.

   Dr. Bodman is an Associate Professor at the Kent State University College of Podiatric Medicine. He is a Diplomate of the American Board of Podiatric Medicine. Dr. Bodman is in private practice in Ohio.

References

Comments

A great article on "fungus nail" involvement with methods, drugs & outcome by my friend Dr. Ron Bodman. I also noticed over the years that there is most definitely an immune system involvement in nail fungus & C. albicans infection. As we say in WV, "it runs in the family." I have seen patients with specific toenails involved & some of their offspring have identical involvement. Some people do not have the ability to defend against the fungus organisms. They are then resistant to curative measures & tend to become reinfected after treatment.

We know fungi like a dark, warm, moist place to grow with a food source. I would like to suggest that perhaps contributing factors leading to an increase in nail & skin fungal infections over the last 20+ years may be connected to external changes in clothing & shoe gear. Over this time, we have seen a real increase in the use of artificial fibers such as nylon and polyester in socks/hosiery. These fabrics do not absorb moisture & raise the local temperature of the foot. There is no wick action with these fibers . Once again, today's shoe gear is entirely or mostly artificial uppers & lowers. These have the same characteristics. The feet are warmer, wetter, dark & there is little or no air circulation. The insoles/linings of the shoes are plastic fibers. The soles are rubber/vinyl.

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