This months newsletter is about a common problem that is difficult to treat: toe nail fungus (also known as onychomycosis). It is difficult to treat for two reasons. 1) a toe nail is nearly impenetrable to creams and other topical medications, and 2) toe nails grow VERY slowly.
When do you actually WANT nail fungus?
Many people present to our office with nails that are yellow and thickened and look “fungal”. The first thing we do is take a nail clipping and send it to the lab. When we find fungus, we have something to treat and we treat it (see below). When we do not find fungus, we are somewhat “stuck”. There are some products that can improve the appearance of these “fungal looking” nails that don’t have any fungus. For example, there are whitening agents to get rid of the yellow color , and urea products which decrease nail thickness. But these treatments are only cosmetic. On the other hand, when we do find fungus, then there is a chance for a “cure”.
Toe nail fungus “cure”:
The most effective way to treat toe nail fungus is with pills. And the most effective pill is terbinafine (Lamisil). But every patient seems to have heard from somewhere that Lamisil “kills your liver”. This is simply not true. There is a tremendous amount of data and experience with Lamisil to support its safety, or we simply would not use it. The biggest problem we have with Lamisil is cost (it is about $10 per pill) and getting it covered by insurance (many companies will not pay for it).
A different approach:
Lamisil is typically prescribed as long course of continuous therapy: one pill a day for two months to treat finger nails; three months for toe nails. We treat nail fungus with a different approach called “pulse therapy”.
The Staff and Doctors at Minars Dermatology
Despite the fact that we mention a specific product (Lamisil) in this newsletter, we have no relationship, financial or otherwise, with Novartis, the company that makes Lamisil (or any other pharmaceutical company). The opinions in this article are based on science, data, and experience only.
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