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Sunday, February 3, 2013

Toenail Fungus

Hello Dr. Blake,

I found your website and have read the toenail fungus section carefully. I have a toenail fungus problem and I am interested in using more simple (non-pharmaceutical) methods in fighting it. Unfortunately I also have a fingernail that got infected by a contaminated nail clipper over a year ago.

I live in a rural area and a few months ago I went to a local dermatologist.  He prescribed Lamisil for my nail fungus. I had already researched the matter and tried to discuss the urea nail removal option but he was not at all interested and was even rude and just cut me off, so to say.  He said, rather sarcastically, "What's the dosage for Urea?!"  I considered the Lamisil option but after looking at a website that had hundreds of people telling about their experiences with side effects in using that, I decided not to go that route.
Dr Blake's comment: If you use Lamisil tablets, I recommend 1 week per month for 6 months. This is called pulsing, and definitely safer than daily dosing for 6 months, and very effective for my patients when I use it this way. Also, if the nails are very thick, the Urea Occlusion technique is more effective than removing the nails, or Laser, in getting the nails to a more normal starting point. See the separate post on Urea Occlusion. Please remember that Lamisil is not benign, and can cause serious side effects. So, have a long conversation with your prescribing doctor. I am definitely recommending now that patients consider laser treatments (even though expensive) first before considering Lamisil. 

I am a "do-it-yourself" type of person and I have been doing soaks of the affected nails for several months now; also, after I do the soaks, I trim the nails (they were a bit softened up by the soak) and cut them way back (up to the cuticle and even beneath it) with some nail trimmers that I have. The nails don't look as ugly that way, but they are still quite unsightly. So, my question for you is this: Is there any way I can get some Carmol 40 Urea and try this myself?
Dr Blake's comment: have your primary care doc order it, and see all the photos on my post. You should be able to do it yourself within reason. 

 I know that I could follow the examples given in your photos. I would go through a podiatrist but I am not a wealthy man and I am afraid that visits to one of those (if I could even find one out here who was open-minded enough to consider this regimen) would wipe me out financially. I don't have health insurance with my job.

Can you tell me how far above the cuticle the nail bed is? The fingertip with the affected nail looks a bit swollen and is a shade or two darker in color than the other fingers.
Dr Blake's comment: The nail bed goes 6-7 mm further towards the arch from the cuticle.

I don't expect free advice from you, and I would be happy to pay you for your counsel and/or any suggestions that you can give me.

Thank you for putting all of this information on your website—it's all very interesting. Your efforts to enlighten others are appreciated!
Dr Blake's comment: Hope this helps.


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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.