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ComPbm.Derm.2

Onychonycosis

QuestionAnswer
Risk Factors Commonly found in ages 40-60 years. Incidence is 20-100 cases/1000 of the population.
Risk Factors Occurs in patients with PVD and other conditions resulting in a suppression of the immune system. Occlusive footwear, communal showering, incomplete drying of the feet before donning shoes.
Physical findings Dry brittle yellow - brown nails. Thickening can eventually cause the nail to lift and fall off. Increase incidence with the presence of Tinea pedis.
Physical Findings Viewing hyphea on a KOH slide under microscope helps with diagnosis but is not needed unless a persistent infection is present.
What Persistent fungal infection of the nail and nail bed.
Treatment (TOPICAL) Topical agents aren’t as effective and require persistence! Miconazole 2%cream bid. Clortrimazole 1% cream bid.
Treatment (TOPICAL) Vicks vaporub used consistently over the entire nail and nail bed has proven effective in many cases and is cheap. Foot soaks and direct application of tea tree oil and rosemary oils have shown some efficacy.
Treatment (ORAL AGENTS) ORAL AGENTS: are effective but expensive and require extra expense due to required lab testing and multiple drug to drug interactions.All oral agent require regular monitoring of hepatic functions and CBC screening for drug induced anemia.
Treatment (ORAL AGENTS) Terbinafine (lamisil) 30 tabs cost 49.00, Toes are treated with 250 mg dly for 12 weeks, fingernails are 250mg dly for 6 weeks.
Treatment (ORAL AGENTS) Itraconazole (sporanox) 30 tabs = 239.oo, Toes are 200mg dly bid for 12weeks, fingernails 200mg dly for 7 days 3 week off the repeat x 2 pulses of 7 days.
Treatment (ORAL AGENTS) Fluconazole (diflucan) 1 box with 12 each for 167.00. Toes are 150 mg tab once weekly till infection is gone, finger nails are treated the same. Out of all the oral agents fluconazole is the least effective for toenails.
Created by: DianaB
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