Aug 26, 2020

Interviewer: They're ugly, and, for some, boom mucus tin be painful and also very tough to become rid of. Dermatologist, Dr. Christopher Hull, what's the first thing you practise when a patient comes in with blast mucus?

Dr. Hull: Well, showtime, I like to make sure that it really is nail fungus, because there are other boom conditions that can look very similar to and mimic nail fungus. And then first that usually involves cess of the nails. Sometimes we'll do some confirmatory testing with clippings and cultures and scrapings. And then, one time nosotros're comfortable that information technology's a fungal infection and non some other condition of the nail that looks like smash fungus, then nosotros talk about how it's affecting them and what they're hoping to achieve as far every bit treatment.

Interviewer: Got information technology. And so if information technology's something else, the handling options would exist dissimilar. That'south why you really want to find out, what . . . information technology is mucus, correct?

Dr. Hull: Right. And treating nail mucus is notoriously very challenging, often with failures along the way. And then it'due south important to exist sure that earlier yous kickoff going down the path of treatment, that you've actually got a correct diagnosis.

Interviewer: And it tin can accept a long time to treat. Then yous wouldn't want to get down this path of treatment so . . . yeah.

Dr. Hull: Right. And some of the treatments require monitoring and have some risks associated with them.

Treatment Options for Blast Fungus

Interviewer: Got it. And then y'all find out it's a nail fungus. At that bespeak, what are the handling options?

Dr. Hull: There are a number of treatments. In that location are many things that are you know, available over the counter. You become to the net and Google "nail fungus treatment," you lot'll come up with 10,000 hits, I bet.

Interviewer: Aye, pills, polishes, creams?

Dr. Hull: Right.

Interviewer: Yeah, all sorts of things. What practise you tend to like to use?

Dr. Hull: Most of those have not been investigated with really good clinical trials. But I think there'south things that people have used and have establish to be helpful. One common matter that comes up are products that comprise menthol. So Vicks VapoRub is a common boom remedy for nail mucus. It probably won't help. Just it won't hurt anything either.

Almost of my conversation is commonly discussing medical therapy, so things that are available by prescription only. And those come in two main forms, which are topical antifungal medications, and then oral antifungal medications. There are other surgical or procedural options, so you tin remove nails besides. And then there's starting to be more interest in technologies similar lasers for nail fungus.

Interviewer: So you lot would said at one point that you accept a chat with the patient, what is it you lot're trying to accomplish. I understand for some people it tin can be very painful. Then it might be to alleviate the thickness of the nail and the pain.

Dr. Hull: Right. And it gets difficult to clip, trim, and groom nails when they become very thick. It can be associated with pain considering of ingrown nails. And in some cases, it tin can also predispose people to infection, so cellulitis and then forth. Then there are medically of import reasons to care for them. Some people just don't like the appearance of the nails.

Interviewer: Yes. Because doesn't look skilful in your flip-flops, does it?

Dr. Hull: Right. Wearing sandals in the summer time with thick, xanthous nails is something that a lot of people would like to not take to do.

Interviewer: So if it isn't necessarily painful, practise you recommend handling? Do you really leave that up to the patient at the point?

Dr. Hull: Yeah. My personal philosophy is to get out it upwards to the patient. So I give them the different options, talk almost the length of treatments, the monitoring, the likelihood of success, and then have a chat with them most whether they want to move forward with those treatments. And a lot of people like not to practise anything and many people are very motivated to care for their nails.

Pros and Cons of Oral Treatments

Interviewer: Sure. What near the oral drugs? I empathize that some people are concerned well-nigh the side furnishings those can cause. So are the oral drugs, generally, better than the topical or . . .

Dr. Hull: Yeah. The oral medications are more effective than topical treatments.

Interviewer: Sure.

Dr. Hull: The good news though is that the rubber of most of these oral medications is very good. And the treatments are likewise much less expensive. So there's quite a bit of price benefit from using the oral medications.

Interviewer: What are some of the concerns with the oral medication side furnishings?

Potential for Liver Toxicity

Dr. Hull: The primary concern is liver toxicity, because these medications are metabolized by the liver. Looking at cost effectiveness of oral versus a topical medication, I'm actually sort of arguing for the oral medication because it's and then much less expensive. But and then, also, looking at a lot of the safety information virtually the medication and the run a risk of serious liver agin event is very depression in that medication. That said, I all the same will recommend appropriate monitoring. And that's laboratory testing, unremarkably a baseline and so midway through the handling.

Interviewer: Are they antibiotic based?

Dr. Hull: They're antifungal, so they're specific towards mucus. So they have no effect on bacterial like an antibiotic would.

Interviewer: And so people that are afraid of antibiotics for whatsoever stomach reasons they might have.

Dr. Hull: Yes. Information technology won't take any effect on the flora of the gut. And actually, interesting, they don't . . . this particular one, terbinafine, doesn't have an outcome on the natural yeast that we run into in the intestine called candida. So it shouldn't accept any result on that. Some people can become rashes, and there's, you know, other less common side effects. But for the virtually role, I discover them to be well tolerated.

Domicile Remedies for Nail Fungus

Interviewer: Some of the dwelling remedies that I saw, you lot mentioned Vicks VapoRub, ophidian root excerpt, tea tree oil . . .

Dr. Hull: I haven't come across ophidian root excerpt even so. Only it sounds like information technology might eat away a nail pretty well.

Interviewer: Sure.

Dr. Hull: Yeah. There's a lot of those things out there. A lot of people utilise vinegar, tea tree oil. The hard part with any of these topical medicines is they don't penetrate the nail unit very well. Then getting them, actually, to the fungus in the nail unit is very hard. And that's why a lot of the prescription topical medicines accept such limited effects.

Interviewer: What nigh do-information technology-yourself at home trying to thin that smash out like, you know, by coating it with . . . what exercise people coat it with?

Dr. Hull: Well, I think doing debridement at home is, actually, helpful. So a lot of times, I'll accept people file their nails downwardly, clip the nails back, because that helps to kind of trim away some of the infected nail every bit well.

Best Candidates for Oral Treatment

Interviewer: Would your recommendation, generally, exist for somebody to use the oral pills if possible just because it's such a shorter treatment time?

Dr. Hull: Well, I think it but depends on the person. There are some people who have other hazard factors, who have a history of liver illness or something where I wouldn't exist comfortable putting them on that medication. So I apply both medications, and sometimes I apply them in combination. So I'll have them practise a first course with an oral antifungal and then follow up with a topical. And that may help prevent reinfection, too, down the road.

Interviewer: Which is pretty common from what I understood.

Dr. Hull: Yeah. Then it's common. You lot can get the blast clear, and then people are just exposed to the fungus in their environment, in their shoes and and then forth, and they tin can become reinfected easily.

Interviewer: And so it sounds like that if somebody does have boom fungus, for the most part, does it carp y'all because it's ugly? If there'due south pain involved, then for certain, you lot would recommend some handling. For some people, there could be other medical reasons to treat it.

Dr. Hull: Right, yes. Somebody with, you know, for example, diabetes who's at take a chance of ulcerations on the feet, cellulitis infections, they are people that may be . . . they may be more proactive about treating to help reduce their risk of infections.

Interviewer: But for the most role, information technology sounds like if y'all don't really have many symptoms, information technology's just kind of a personal pick?

Dr. Hull: That's true.


updated: Baronial 26, 2020
originally published: July nineteen, 2017

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