Showing posts with label onychomycosis. Show all posts
Showing posts with label onychomycosis. Show all posts

Saturday, July 25, 2009

Laser treatment for toenail fungus

This is an interesting one to blog about, but has everything to do with innovation and bringing products to the market. The laser treatment for toenail fungus (onychomycosis) is a recent innovation. The clinical trials by the company, PinPointe, are underway and no results are yet available. However, many clinics are beginning to widely use and tout this treatment. All the evidence for it is the testimonials and unsubstantiated claims. There are many clips on You Tube about it. Its not cheap and costs a lot of money. My interest in this was piqued when this marketing of a product before the evidence comes in as to its efficacy is lacking. This is a pattern that has been repeated many times in the history of the profession. More often than not, the use of the product dies off as the evidence come in. Don’t we ever learn by our mistakes?

(See this on Podiatry Arena: Nail fungus laser treatment; Laser treatment for nail fungus)

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Sunday, March 15, 2009

Tea Tree Oil

Tea Tree Oil is an 'alternative' medicine. Its seems to be popular amoung Podiatrists in the UK and some in Australia and NZ, but not used widely in the USA (why is that?). It has been shown to be no better than a placebo for the treatment of onychomycosis, yet so many still use it (why is that?). The EU have expressed safety concerns about it, yet many still use it (why is that?) (see: Tea tree oil faces ban over health fear). See these discussions:
Whats your Gold Standard for onychomycosis?
Is there a place for tea tree oil in foot care?
I just can not understand the rationale of those that use it (...there is always the argument that "I used it and got some good results" -- BUT, according to the evidence, a placebo would have got the same results).

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Sunday, January 29, 2006

How important is debridement in onychomycosis?

This paper has generated some good discussion:
Study to determine the efficacy of Clotrimazole 1% cream for the treatment of onychomycosis in association with the mechanical reduction of the nail plate
"Onychomycosis is invasion of the nail by dermatophytes yeasts and moulds [Calderon RA, Hay RJ. Fungicidal activity of human neutrophils and monocytes on dermatophyte fungi Tri. Quinckeanum and Tri. Rubrum. Immunology 1986;61:289–95; Degreef H. Onychomycosis. Br J Clin Pract Syn Suppl 1990;71:91–7; Zaias N. Clinical manifestations of onychomycosis. Clin Exp Dermatol 1992;17(1):6–7]. Causative organisms include T. rubrum and T. mentagrophytes. Fungi invade the distal and lateral under surfaces of the nail. The prevalence of onychomycosis approximates to 5–10% of the population and is increasing significantly in recent years [Stutz A. Allylamine derivatives—a new class of active substances in antifungal chemotherapy. Angew Chem 1987;2:320–8].Clotrimazole 1% cream is the most commonly prescribed topical antifungal agent in the United Kingdom although its use on nails has not been widely documented. Past inefficiencies may be due to the thickness of the nail plate. The mechanical reduction of the nail minimises the nail as a barrier to the absorption of the cream and increases the permeability of the nail plate.Subjects were ambulant and healthy with no systemic medication, no past history of anti-fungal agents and an ankle-brachial index indicating sufficient circulation for healing to occur. The infecting organism was identified by microscopy and culture. A total of ninety-two infected nails were isolated over a four-year period. The age range was 60–78 years. Nails were drilled every 14 days by the same operator and the area of infection mapped. Clotrimazole 1% cream was applied twice daily during the trial period and the percentage clearance rate was recorded. After 12 weeks there was an average improvement of 96.2% with the infection in 80% nails completely resolved. "
Discussion

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