Month: October 2015

Fungal Nails

Laser for Fungal Nails

Posted on | by Neil

Fungal nails, Onychomycosis affect about between 10% and 40% of the population depending which survey you believe, judging by the amount pharmaceutical companies are prepared to spend on national television advertising there are a lot of people suffering with this condition.

Fungus usually presents as discoloured nails darkened, green/yellow or even white the nail is often crumbly and friable and may or may not be thickened. I am often asked ‘how did I catch this’ and my usual response is damage is the most common cause. The nail is damaged either from acute trauma like kicking the curb, or from more chronic trauma like tight footwear.

The damage to the nail allows the fungus to get into the nail and start eating away at the keratin; the protein nails are made of.

There are other conditions which may look like fungus these include psoriasis and onychomycosis or thickening of the nail. So the first visit is always important to establish that the problem is fungus and not something else.

Before laser the only effective treatments fungal nails were topical paints and lacquers and tablets and although these treatments can be effective they do have their drawbacks as well. Tablets do have potential side effects, liver damage being the one of most concern, but also other less serious problems.

Paints and lacquers work well for fungal nails but require the nail to be cut right back and the treatment takes a long time sometimes more than a year. So people give up or stop before the problem has fully resolved.

The advantage of laser is that it is effective 70/80% success rate, painless no side effects and the patient doesn’t have to do anything themselves.

SO WHAT DOES FUNGAL NAILS TREATMENT INVOLVE?

Well once it is established that it is fungus then treatment starts with cutting the nail back and removing as much infected nail as possible. This has two purposes, one it makes the nails look a whole lot better and two it helps the treatment to be more effective.

Then laser is applied to each affected toe for four to six minutes
THIS IS A PAINLESS PROCESS

Initially four sessions are required and I usually spread them out over a couple of months, as we still have to wait for the nail to grow to see progress. Often only four sessions are required but sometimes I will do a follow up a month or so later and laser again then if required.

If you are interested or require more information about Fungal Nails why not visit my website www.footpodiatrist.com or give me a call on 686912307, if I’m with a patient and do not answer, leave a message and I will call you right back.

Dermatology and Feet

Dermatology and Feet

Posted on | by Neil

One of the many facets of podiatry is dermatology and if you think about it, feet are covered in skin and nails are just an adaption of skin.

There is now a podiatric speciality known as Podiatric dermatology which has grown out of the fact, that as a podiatrist much of what you do crosses over into dermatology and therefore many podiatrists want to know even more and specialise in this area.

When I go to conferences dermatology lectures are always packed. Many of the routine treatments I am involved in are dermatological in nature, Hyperkeratosis (callous), Heloma durum (corns), Human papiloma virus (verrucas) Onycomycosis (nail fungus) are all dermatological complaints which podiatrists treat every day. There are also the more serious skin conditions that often present in clinic.

Skin cancer is very common in feet as after to hands and faces feet are exposed to the sun probably more than any part of the body. From solar Keratosis sometimes known as sun spots, Squamous cell carcinoma, Basal cell carcinoma and even malignant Melanoma are all commonly seen on feet.

I think I have mentioned before that one of the differential diagnosis for ingrown toenails particularly if they are persistent, is malignant Melanoma. Obviously with skin cancers it is not a podiatrist’s role to treat them and swift referral especially in the case of suspected Melanoma to a Dermatologist is essential.

But malignancy aside, there are still many skin conditions of the feet that podiatrists treat very well. Cracked heels are very treatable with debridement and advice on the correct emollients. Often cracked or split heels are a symptom of psoriasis and psoriasis has other manifestations in the feet one of which is psoriatic nails. These often look just like fungal nails and although the psoriasis in nails cannot be eliminated it can be managed very well by reducing the nail bulk and improving appearance.

Athlete’s foot which is really a fungal infection is a very common presentation in clinic in its many forms. Even bacterial infections like Pitted Keratolysis where white holes are seen in the bottom of the feet especially when wet are very treatable in clinic.

There are too many skin conditions seen in feet to mention them all, but the above are a few which are commonly seen.