March 4th I attended the 14th annual scientific session of the Council for Nail Disorders, which coin-sided with the American Academy of Dermatology meeting in Miami. The meeting brought 62 physicians, 60 dermatologists and 2 podiatrists from all over the globe.
The subject matter presented was cutting edge from the world's most re-owned experts. Topics included nail tumors, reviews and update on recent literature and research involving the nails, nail surgery and nail pathology including onychomycosis (Fungal infections)
Take away points
- Diagnosis and treatment of nail tumors is under diagnosed
- A correlation between fungus from the toenails and fingernails
- Use of combination of urea and anti fungal topical creams prevent recurrence.
- Presence of yeast, hyperhidrosis (sweaty feet) and smoking inhabits a patients cure.
- Laser (near infrared) treatment very promising in treating fungal infections.
- Laser (near infrared) also promising for treating psoriatic nails.
- Recurrent infections should be biopsied to rule out malignancy.
The meeting was very insightful and beneficial. I look forward to continual participation with the Council on future studies and research.
FUNGAL NAILS (ONYCHOMYCOSIS)
Fungus infections of the nails are very common and it appears that the incidence is increasing. Fungal toenails are the most common dermatological infection of the foot.
Onychomycosis is the number one disease treated by podiatrist in the United States and is seen in 20% of individuals 40 to 60 years of age, 32% in individuals between 40-70 years of age and 50% in those over 70.
Fungus is contagious to others and it can spread to other locations in the patients body. Most believe nail trauma and exposure to fungus (i.e. shoes, spas, and family members) are the cause. Some researchers believe there is a generic predisposition that causes some people to have an immune sensitivity to these infections.
The most common organism found in most infections is T.Rubrum. The disease is characterized by a thickening of the toenail, debris under the nail plate, lifting of the edge of the nail, color change and odor.
Although the condition is most often painless, cosmetically it can be ugly and embarrassing. Most people seek podiatric care for a solution.
The treatment for onychomycosis involves five basic options:
- Debridment (reduction of the nail thickness)
- Topical medications
- Surgical removal of infected toenail
- Oral medication
- New laser therapy
Debridment does not treat the infection. It will reduce the thickness and may improve the cosmetic appearance, but must be done monthly as the normal nail grows out about (2mm) a month. Fungal nails may grow at twice the rate.
Surgical removal and destruction of the root ( matrixectomy) may be effective at eliminating the infection, but may result in other problems as the end of the toe is now unprotected without a nail. Most patients do not choose these options as it cosmetically is unappealing.
Topical treatments are many, however, most have from 5-20% success rate. Although many pharmaceutical companies are in search of a good topical solution, it is not here yet.
Oral medications have been very effective, however, they all have poor safety profiles including cardiac, liver and kidney concern that require monthly blood testing and monitoring by a physician. There are also reinfection risks.
Laser therapy is the newest technology int he fight against the dreaded fungus infection. High powered pulse lasers that target the fungus with usually one treatment. It does not require anesthesia has a clinical efficacy of 88%.
Once fungus is cleared there are proactive prevention measures that are strongly advised:
- Proper hygiene
- Keeping the feet dry
- Inspecting between the toes
- Shower shoes for public areas
- Breathable shoes
- Anti-fungal shoe sprays
- U.V. light shoe trees also help kill fungus
- Not sharing pedicure instruments
- Bring your own polish to salons
- Avoid repetitive trauma (tight shoes, picking at nails)
Research is suggesting a 40% urea cream combined with an anti fungal cream is the best topical option for preventing reinfection.
Are nail salons safe??
Women who frequently visit nail salons should be concerned that they are at potential risk for; athletes foot, fungal infections, warts, hepatitis, HIV, and MRSA.
Dr. Dorfman recommends some very basic guidelines:
- If you get the feeling that a salon is not clean- leave.
- Ask how they sterilize instruments( Heat autoclaves are the best method)
- Technicians should wear gloves and wash their hands between clients.
- Food and drinks should not be kept at the work station as this is a hygiene standard.
- If the technician has sores/cuts or warts leave.
- Watch the technician clean and disinfect the basin and whirlpool.
- Bring your own instruments and polish.
Some states have stricter standards than others, however, these standards are only good if they are enforced. It is your health and you have the right to observe and ask questions concerning these issues.
Thank you to all the wonderful East Ocean Podiatry patients and suppliers that donated socks to help the homeless. This drive far exceeded our wildest dreams. We collected to date 1450 pairs of socks. Some patients donated money, which we used to purchase underwear. Thrift stores cannot accept used undergarments so the Lord's Place was thrilled we were able to take care of another need. On January 29th we went with Dr. Dorfman while he treated the feet of about 45 homeless at the Lord's Place in West Palm Beach. We were able to give each of them several pairs of socks and underwear. A supplier donated some shoes and we were able to fit about half of our visitors with new shoes. We were also able to donate compression stockings, antifungal powder, ace bandages and foot creams provided by East Ocean Podiatry.
Because of the generosity of so many people the socks continue to come as does the cold weather. This past week we donated another 120 pair of socks to NE Focal Point in Deerfield Beach. They are not a homeless shelter, but work closely with the homeless in our community and other shelters. They said socks are in great need.
"Ankles Away" for Dwight Freeney
I can't imagine Dwight Freeney of the Indianapolis Colts playing on what has been described as a grade 2 ankle sprain of his right ankle.
Playing right defensive end requires excessive force on the right ankle as he tried to get around the end.
A grade 3 ankle sprain is one in which all 3 of the ligaments that would hold the ankle stable ( bone to bone stability) are torn. This usually fro a professional athlete means surgical correction.
If they send him out to play in the Superbowl it probably means a local anesthetic, lots of tape and a fitted in shoe hinged brace. Without feeling he can certainly have a career threatening result. This certainly brings up a whole host of medical questions.
Lets hope that Dwight chooses whats on his best interest, as it is only a game, be it the Superbowl , walking is not overrated.
