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Just out of curiosity who advises their patients to use tea tree oil for fungual nail infections. I have come across various amounts of research which suggests that it is a great form of treatment for getting rid of mycosis.

Alot of the off the shelf brands are expensive and take a long time for results - however, i am also aware that patient compliance is a huge factor in treating this condition .

Would appreciate any suggestions?

Anyone using Tea Tree Oil for mycotic nails is being irresponsible and unethical. It does not work and the EU are even thinking of banning it.

http://www.podiatry-arena.com/podiat...ad.php?t=19758

Have a look at Blinda's post in the above thread mentioned by DaVinci - its a good post.

Also didn't Paul Tinley from CSU publish some data on this a few years back saying about the only thing tea tree oil did was cause allergic contact dermatitis in 5% of users???

Food for thought.

Thanks for that - i was really shocked by that literature and will stop suggesting it to patients for mycotic nails - and stick with referring patients to their pharmacy or GP

Why do that? Topical Loceryl 5% is available over the counter, so is topical gordochom...Nail ablation with phenol is an option, pathology is available to Podiatrists (especially if you work in public health) so samples shouldn't be an issue. Referral for oral terbinafine is about the only reason to send off for at present.

I went more for that option as some of my colleagues referred me to the literature so I started introducing it myself - however i obviously did not do enough research. I am a fairly recent graduate so am still learning all the time, however, it appears that I have made a fairly big mistake and thank you all for referring me to the above.

I know that topical loceryl is a good treatment for mycotic nails - but its also expensive. I have also had patients taking oral terbinafine who have complained of significant side effects namely GI upsets so have been reluctant to pursue this option unless it is a significant problem and all other avenues fail.

I realise i need to utilise the conservative methods before considering invasive treatments.

Once again many thanks.

Try Gordochom - 1/3rd the price of Loceryl 5%.....ALso search the threads here for the PinPoint laser for onycomycoses information. its a really good thread with some awesome posts....

Can anybody point me to any study that demonstrates Gordochom is of any benefit in the treatment of fungal nails & if so how does it compare to other medications such as Loceryl, Daktarin & oral anti-fungals?

I can't recall seeing any study looking at the benefits of Gordochom in the management of fungal nail infections.

Its generic name is:

Topical chloroxylenol-undecylenic acid

As far as I am aware there are no current clinical trials (http://www.anzctr.org.au/default.aspx) (http://clinicaltrials.gov/) in Australia or the US.

Check this thread and in particular the cochrane review mentioned by Stephen Tucker:

http://www.podiatry-arena.com/podiat...ad.php?t=22589

Here is a paper which summarizes reports of lack of efficacy and cellulitis associated with 15 topical antifungal agents (take a look at table 1):

http://www.google.com/url?sa=t&sourc...H0HJBMnMRNKwnQ

This paper discusses topical antifungal care for compounding chemists - no idea which Journal this is from though, its a cool little article which discusses the above:

http://www.google.com/url?sa=t&sourc...Wxaqu5uByB4mcQ

JAPMA have this:

Journal of the American Podiatric Medical Association
Volume 93 Number 2 136-141 2003
Copyright © 2003 American Podiatric Medical Association
Topical Treatments for Onychomycosis
A Historical Perspective
Myron A. Bodman, DPM*, Lisa Feder, PhD{dagger} and Angela M. Nace, PharmD{dagger}

* Cleveland Foot and Ankle Clinic, Ohio College of Podiatric Medicine, Cleveland.
{dagger} Scientific Connexions, Newtown, PA.
This article was supported by an unrestricted educational grant from Dermik Laboratories, Berwyn, Pennsylvania. Drs. Feder and Nace both received funding from Dermik Laboratories. Dr. Bodman has received monetary compensation for speaking engagements from Dermik Laboratories.

Corresponding author: Myron A. Bodman, DPM, Cleveland Foot and Ankle Clinic, Ohio College of Podiatric Medicine, 10515 Carnegie Ave, Cleveland, OH 44106.

Abstract

Topical treatment of onychomycosis, in contrast to systemic oral therapy, allows the patient to apply medication directly to the affected area, thereby decreasing the potential for adverse events and drug interactions. Historically, several topical antifungal agents have been used in the treatment of onychomycosis; however, the evidence for their effectiveness is based on very limited data or anecdotal reports. Recently, the development of new, effective topical agents has renewed interest in this form of therapy. As clinical experience with newer topical agents expands, they may be found to be an effective option for the treatment of onychomycosis. (J Am Podiatr Med Assoc 93(2): 136-141, 2003)

I dont have the full article but I have been told it mentions chloroxylenol-undecylenic acid.

..and come on if Mr Rob Mair Podiatrist extraordinaire in NSW recommends it then it must be amazing. Jeez I wonder if Rob knows they are using this, i'll email him tomorrow!!!!

Quote from Gordochom Distributor homepage:

"In May 1999 Mr.R.J.Mair, Principal of Ryde Podiatry Centre, NSW, has written to us, quote: “Our practice is most interested in trialing and supplying Gordochom Solution to our patients........our enquiry follows the successful treatment of one of our patients Mrs.(name supplied) who is the wife of well known media medical personality Dr. (name supplied). I recommended........appropriate samples which have worked tremendously well.” And ever since this practice, as well as many others, has been dispensing “Gordochom Solution” to its patients."

http://www.porattmedico.com/gordochom.htm

Other links:

http://www.pdr.net/druginformation/D...hom%20Solution

http://www.drugs.com/pregnancy/chlor...d-topical.html

The baseline is its a topical application, has limited use really but is harmless and extremely cost effective.

Also available in the UK from Trycare Ltd.

I haven't used this product although I would be interested in any more feedback.

Regards,

Mandy.

__________________
:)
twirly

Mandy Brooks
Brooks Podiatry
S64 0DE

Suffering a fondness for odd things.

Ta for that Mand`

Having a shifty at the ingredients;

I`ve never used it either but as it`s a fungistatic (stops the fungus in its tracks) treatment will depend on skin cell turnover to work, so if not used regularly, or long enough, will have little or no effect.

However, Amorolfine (Loceryly or Curanail) as an allylamine is fungicidal (kills the fungus), so this would be my preferred tx of choice.....NEVER TTO!

Cheers,
Bel

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Winchester Podiatry (UK)

[quote]
Paul and others heres the full text of JAPMA paper for you to look at if you want.

Attached Files

Topical tx for onychomycosis a historical perspective.pdf (75.8 KB, 35 views)

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Michael Weber

The most common thing about common sense is it´s not very common.

My location

I Love this one!!!!!!
"as effective" - what does that mean?
================================================
Fungal Infection of the Toenails
A randomized, controlled trial published in the Journal of Family Practice looked at the twice-daily application of 100% tea tree oil or 1% clotrimazole solution (a topical antifungal medication) in 177 people with toenail fungal infection. After 6 months, the tea tree oil was found to be as effective as the topical antifungal, based on clinical assessment and toenail cultures.

That is, neither worked!

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Graham Curryer

None of us know what we are doing, but some of us know more about what we are not doing than others!::

LOL - sad but probably true.....thats great "research" speak right there.

True but at 1/3 the price and with a chance of still being effective? Might be worth a shot!!!

I advise people to use tea tree oil largely because it won't hurt if it doesn't do any good, and it gives them something positive to do. If it works then it's a bonus. And it smells ok

Indeed.

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Winchester Podiatry (UK)

I`m afraid I cannot agree with one word of this post. TTO can and DOES cause harm!

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Winchester Podiatry (UK)

Agreed. Continuing to use Tea Tree Oil is being unethical given what we now know about it.

Triple agreed - causes burns and allergic contact dermatitis? Where does it say it does no harm?

Might be time to rethink that advice......

fungi I was taught in all its different forms is ubiquitous and always untreatable. Although as far as I am aware, non life threatening.But can be a disaster to vanity. My advise to any one making an expedition to the sun soaked beaches with their mycotic nails is to stick their feet in the sand. The positive effect could be that the chances of developing a melanoma on the feet would be considerably reduced.

Hi,

I read somewhere that the superficial white onychomycosis can be quite easily treated topically with most applications. however the more common and deeper infections that we are likely to see on a daily basis had very low cure rates with topical therapy alone - and we are talking months and months of applying the 'gunk' to the nail. oral antifungal meds such as lamisil have quite high cure rates - i believe somewhere in the 60's% with a much lower relapse rate than other medications over time.

there was also a study were combination therapy of oral and topical had high cure rates - amorolfine and lamisil if i remember correctly. Most studies as mentioned already seem to indicate that topical medication alone is associated with low cure rates and furthermore that once you stop using the oincment - very high relapse rates are likely to follow (depressing isnt it!!)

in view of this, when a nail is thoroughly infected through the nail plate an oral medication is indicated

Peter

Indeed. In fact SWOM can often be removed with a simple nail file or bur.

True. However, I would be reluctant to use the term `cure` with such chronic infection, mainly due to the high recurrence rates. Something to do with susceptibility to re-infection associated with resistant anti microbial peptides…..but that`s another debate. Incidence of re- infection is also due to dermatophytes have long survival periods and can live on a single skin squame for two years or more!

Yep. One of the earlier key studies (there have been quite a few since) was by Baran et al (2001). A shorter treatment period of Amorolfine combined with oral terbinafine, in comparison to terbinafine alone, resulted in improved outcomes, indicating that a reduction of the duration of oral dosage could be possible whilst maintaining and improving efficacy. This would, of course, result in increased patient tolerance and concordance.

IMHO, all this debate about which fungal nail treatment works and which does not, is not so significant as the development of new treatment strategies or maintenance of this pathology which a large number of the population are prone to recurrence of regardless of how effective initial treatment was.

Cheers,
Bel

Baran R (2001) New Evidence for the Efficacy of Combination Therapy in Onychomycosis, British Journal of Dermatology. 145(60):1.

Baran R, Feuilhad M et al (2000) A Randomized Trial Of Amorolfine 5% Solution Nail Lacquer Combined With Oral Terbinafine Compared With Terbinafine Alone In The Treatment Of Dermatophylic Toenail Onychomycosis Affecting The Matrix Region. British Journal of Dermatology. 142:1177-1183.

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Winchester Podiatry (UK)

"susceptibility to re-infection " and "large number of the population are prone to recurrence " This is my problem with recommending long courses of oral medication, which can put the liver, for example, at risk to treat a condition which, as someone remarked earlier, is only a threat to vanity. Having said that we would all love to have the answer.
Séamus

Hi Séamus

That`s why most GP`s will only prescribe terbinafine for either one month or three and often only after a liver function test is performed if there is any concern.

I wouldn`t entirely agree that it "is ONLY a threat to vanity" in all cases. Fungal breakdown of the epidermis can lead to secondary infection by more pathogenic organisms. There are studies currently underway exploring the association between cellulitis and tinea. For those `at risk` surely it is better to address, whether that be attempting to `cure` or monitor and maintain, any infection that increases risk of secondary infection?

http://dermatology.jwatch.org/cgi/co...ull/1997/301/1

Cheers,
Bel

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Winchester Podiatry (UK)

Hi All
I would just like to add one little note to the discussion. As I am not an aromatherapist and have no training in the effects or side effects of these oils including TT oil and lavender oil (which also seems to be popular as a cure-all) I feel these `treatments` are outside my scope of practice and I don't use or recommend them to patients.

Regards

Deborah