fungal nail infection what to use in the older patient

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Hi
what do pods use in the treatment of the older patient with clinically looking fungal nails?

Would you take a sample for culture from all patients prior to starting therapy?

Thanks in advance for you opinions.

anthony

 

Hi Anthony,
These can be useful,

http://www.supplefeet.com/store/1/2...st/home_testing_kit_for_fungal_infection.aspx

It is important to take the sample from the underside of the nail, if possible, to make sure some hyphae are collected, otherwise a false negative can result.

Some patients will be reluctant to pay for this kit, as they can get a sample tested for free under the NHS, via their GP.

I would always encourage a test sample to be taken prior to any proposed treatment regime, otherwise the exercise can be a waste of your time and the patient's money.

I can't advise on which OTC preparations to use, as they are all much the same to me. I haven't found one that stands out as being more efficacious than any other.

HTH

regards

Podess.

 

Thank you for you advice.

the dilemma I have is the shear number of the old patient with clinical looking o/m nails.

I have been adopting the "well if is not getting worse" approach to limit culture requests but seems a little random.

Spoke to the GPs in the clinics and we come up with a system where all possible oral therapy suitable patients have to have a + culture.

And those we felt would have a good outcome from topical therapy went by clinical appearance.

I am talking about one in three patients with suspected o/m.

And the cost to send samples for this amount is very high.

do you think this is a fair approach ?

thanks
anthony

 

Why not do the tests yourself? They are not that expensive from Cannonbury.

 

NHS patients Suzanne
But good idea
Thanks
Anthony

 

http://www.jabfm.com/content/24/1/69.full

Vicks vapo rub has been discussed here before, and although it is not a cure all, (what is?) it does have some positive effects on a good number of people.
If you really do have that many patients, you could do your own, larger study!

 

Quote from the study:

"We demonstrated in this pilot study that Vicks VapoRub provides a positive effect in the treatment of onychomycosis. This is the first clinical study in the literature to describe this finding."

Those two sentences from that study are enough to make me believe its BS.

I'd imagine vicks vapor rub versus TIME as another treatment variable would give the same results.....

 

Of course! No control group. No blinding of participants. No blinding of assessors, so of course they did not show what they claimed they showed.

 

You mean, where they claimed;

Nice work. Particularly when Trichophyton rubrum dermatophytes are the most common pathogen in OM. Note that only 4 out of the 18 participants showed complete clinical and mycological cure and none of those 4 had tested positive for Tri rubrum prior to the treatment!

My favourite bit;

Right. Clinical outcomes aren`t important, so long as the treatment is simple and innocuous...

 

hi
I do see a large number of patients with ? om in the last two contracts.
This is more then I would normally see.

Its a tricky on for me as I feel that it should be recorded in the notes as suspected OM but due to the numbers cannot seem to justify asking GP for loads of Px for topical paint.

What do you think of using a general anti-fungal cream following nail reduction with the drill?

Would try the Vicks but feel could not justify the use with little clinical evidence.

Do you think tea tree could be a better thought as had read about it been used?

Thanks
Anthony

 

Nope. It does not work either = snake oil

http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=19758

 

This is me leaving the room, quietly...........

G`night.

 

snake oil?

what is that (from a snake? )I bet I have just asked a silly question
thanks
Anthony

 

"a substance with no real medicinal value sold as a remedy for all diseases"
http://www.encyclopedia.com/doc/1O999-snakeoil.html

 

yep, I knew I would have asked a silly question!
Thanks Craig will read the info

 

I didn't even see those laughable lines thanks for pointing them out! You honestly got that far into reading this study Belinda! You are a more patient person than I..... The older I get the less tolerance I have for BS published research that goes against common sense. I am changing the way I evaluate all of the research articles now:

1) Does the study TITLE make any clinical sense at all: YES - keep reading NO - throw it away.

Suffice to say a large amount of research that passes across my desk ends up in the recycling bin!