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Doctors' Answers to "Frequently Asked Questions" - Fungus

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Nail fungus (toenail)[posted 1/4/99]
Question:  What is the product just very recently approved by FDA for nail fungus? I understand it is topical, and is either a polish(lacquer) or cream based product. 

Answer: I haven't heard of this one. Currently the only ones that work are systemic pills.  

Foot Fungus Prevention [posted 11/24/98]
Question:  My mother-in-law has a fungus on two of her toes. Is there anything that she can do to prevent this, such as her diet or a home remedy? She went to the doctor and he gave her some cream to put on it, he also told her that there are pills that you can take to prevent it, but it cost about $200 a month. We can't afford that. Thanks for any information that you can give me. 

Answer: Keep her toes dry, use the medication topically 3-4 weeks after all superficial signs are gone and use a sterilizing spray in her bathroom to kill all remaining spores. 

Ringworm Fungal Infections [posted 11/21/98]
Question:  I have had ringworm for almost a year now and have been to my doctors 4 times trying to cure it. Meanwhile it has spread all over my body, currently I am taking grisofluvin, but it is not working at all. My doctor doesn't seem to be informed on ringworm because she told me not to even waste my time in coming back to see her since she can't treat it. Would a dermatologist be better? And which antifungal medicine works the best? I have heard about lamisil and sporanax. I would appreciate it if you can tell me which will work best so that I can suggest to my doctor some other treatments. 

Answer: First, get a biopsy to see what you are treating. Second get a new doctor, a dermatologist would be find. The lamisil and sporanax are better drugs and might work fine, but, you need a diagnosis after this amount of time. 

Identifying Possible Fungal Infection [posted 11/4/98]
Question: My son has a greenish discloration on a large areas of his back. Could it be a fungal infection of some sort. He began showing autistic symptoms at the age of 1yr 6months. Could there be any link? I have read of kids showing autistic symptoms when afflicted with fungal infections e.g. Candida.

Answer: Hard to tell without seeing it. Greenish discoloration would be very unusual for most skin fungal infections. You'll need a health professional to see the distribution, color, etc.

Stubborn Nail Fungus Treatment [posted 11/3/98]
Question: I would like to know if there are any treatments you would recommend for psoriasis of the fingernails. I have visited numerous dermatologists and nothing they have prescribed seems to help. I have had this for a few years now. At first, the diagnosis was fungus of the nails. After being treated for that and no change occured, they ran a few tests and found that it was psoriasis. This is a very embarressing problem, and I would deeply appreciate any advice you may have on this matter. In advance, I thank you for your help.

Answer: Sometimes methotrexate will work, but often nothing controls this problem.

Nail Fungus Treatment Preferences
Question: What is the current treatment of choice for nail fungal infection (onychomycosis) in an otherwise healthy patient? Sporonox, Lamisil other?

Answer: Depends on the md and their philosophy. They all work about the same and have potential liver toxicity, cost can be a factor as well depending on patient resources. I usually use sporonox.

Nail Fungus
Question: What can be done for toenail fungus? I hear that medication is not only expensive, but can be dangerous.

Answer: There are antifungals that will kill nail fungus infections. Since the toe nails take about 6 months to grow out there must be treatment for at least 6 months and often for one year. The original medications have the risk of liver toxicity and are rarely used. Newer medications like Sporonex are given for one to two weeks a month due to their ability to concentrate in the nailbed. They work better with less liver toxicity since there is a lower overall dosage. However, I rarely use them because these infections are only cosmetic. They will not spread to your body and will not cause other problems.

Fungal Infection
Question: I have two infections. Athlete's foot and infection in the nose. Could there be a relation between these two? For the Athlete's foot I can keep this under control with tolnaftate. However, if I stop the treatment for a week, it comes back. My nose is very dry and itchy and respiration is very difficult. I control the infection with hot towels because Cortisone cream does not help much. When it is swollen, I use hot towels and the antibiotic cream neosporin. I am 67 years old. These two infections are well established as chronic. I consult a specialist once a year and leave his office with a new tube of medication. Last time was an aural intake cortisone treatment. Is my immune system in bad condition?

Answer: The two are probably separate. First, in treating the fungal infection of the foot you will need to apply the topical antifungal for 3 to 4 weeks after the infection is superficially gone. This is because the fungal spores will stay in the deep dermis until a compete layer of skin grows out (about 3 weeks). Then you need to ensure that your bath tub and anywhere that your feet are bare is free of fungal spores. Initially, this means twice a week cleaning with an antifungal preparation. If you use common showers like a health club wear shower shoes to keep your feet off the tiles. After the infection is clear apply the topical cream anytime you use the health club's shower. I'm not quite sure what the nasal infection is. Do systemic antibiotics help? Did the cortisone help?

Fungal Infections
Question: I contracted ringworm about 4 years ago and keep having outbreaks of it. I've been to the doctor several times during the last few years. Lambsil cream seems to help but I keep getting it back again. My doctor gave me 4 sample pills of lambsil oral medication and it seemed to clear up right away, but it still comes back on my ankles and lower leg area.. Do you have any suggestions for me? Also, if I get a prescription of oral medication how much do I need to take and for how long? - because I am apparently not completely killing the fungus.

Answer: The usual reason for return of ringworm is insufficient time taking the drug. A complete layer of skin must grow out before the infection will clear. This can take up to 4-6 weeks for most patients. Topical use of antifungals for extended periods will usually work.

Question: My wife is pregnant. During her pregnancy, we've had a few fireplace fires with wet wood that had a green fungus on it. My concern is if the fungus gets airborne and she inhales it would it hurt our baby?

Answer: There are a few funguses that grow on wood that could spread to people. These usually require being aerosolized by saw blades, etc. Casual contact would be extremely rare. The most usual fungus in this category is Blastomycosis dermatitis. Most infections are limited to the lung although they occasionally spread to other organs in the body. Infection is heralded by fever, cough, myalgia and malaise. Although I am aware of this disease I have never seen a case in 15 years of practice. As noted, most cases involve workers in wood factories who inhale the fungus after mechanical aerosolization.

Question: Are there any new drugs coming for thrush? The patient's thrush has become resistant to most drugs including Diflucan Spornox, Mycelex, Ampho, "B."

Answer: There are new agents for fungal diseases being developed constantly. However, none are immediately on the horizon for release. Thrush does not become "resistant" to these drugs. However, recurring infections caused by underlying medical conditions can cause repeat infections.

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