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I have a patient who has 4 nails affected and has tried all mainstream topical products including tea tree. He is unable to take oral anti fungals due to medical reasons. Is there anything else he can try? He has had this for years now and is desperate to get rid of it. Any suggestions would be welcome.
Thanks,
Yvonne

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Depending on severity you could try chemical anil avulsion, using a 40-50% urea compound.
Or, try Ciclopirox applying to nail bed and 5 mm to surrounding areas. Dont remove between application but apply each coat daily (8 hrs before washing) on top of existing coat. Every 7 days remove with alcohol, then start again.

hope that helps

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What do you mean by "all the mainstream topical products" You could try grinding down the the affected nails to remove as much of the fungal infection as possible and they use Loceryl (amorolfine) varnish twice a week. Keep grinding down at each visit at 4-6weekly intervals. I also use 5% hydrogen peroxide to clean the nail and surroundings and advise on antifungal treatment of shoes/slippers.
Zsuzsanna