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May 29, 2005
To treat or not to treat?

Foot care is an important aspect of diabetes health maintenance.  During this rotation, I encountered a few patients with foot fungal nail infection.  Usually these patients are referred to a podiatrist for foot care.  However, some of these patients do not have the time or their insurance does not cover foot care, so they wondered if it is something they really need to treat.

Therapy can be divided into topical, oral, and surgical therapy.  Topical agents such as ciclopirox olamine can be painted on the infected nail, however it is not effective in serious cases where the infection has penetrate into the nail.  Oral agents such as griseofulvin and ketoconazole must be use as adjunctive therapy in serious cases, however they have many adverse effects, require close lab monitoring and prolong treatment.  Newer agents such as itraconazole and terbinafine have shorter time of treatment and few side effects, but rate of relapse is high.  Surgical removal of the infected nail is effective especially when used in conjunction with oral therapy. 

Onychomycosis or fungal nail infection is condition that can infect anyone, however older people with diabetes are more susceptible.  While onychomycosis is not a life threatening condition, it can cause infection of the adjacent skin which can lead to serious infection such as cellulites and osteomyelitis.  The decision to treat onychomycosis must be base on individual risk factor of infection, balance with the cost of prolonged medication use and side-effects. 

Posted At : 7:14 PM. | Link | Rotation 5 04-05 | Comments (3)

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Good posting, unfortunately I was only able to open the emedicine link so I am still wondering if you really need to treat onychomycosis. I have seen this in both young and old patients and they have not been diabetics.

Posted By Marcela Mcdonald / Posted At 5/31/05 10:20 PM

an important topic; as marcela notes, was unable to open link about need to treat onychomycosis.

Posted By Jacqueline Vanderzanden / Posted At 6/1/05 11:41 AM

This is a very concise and important post. I'm surprised you've only encountered a few patients with this infection. I feel like it is the minority for patients seen in the office to have good foot care. There have been no referrals that I've noted to a podiatrist, and most diabetes patients are either already hooked up with one, or do their own foot care. The provider's I worked with did not seem overly eager to treat, because of the side effect profile of the drugs. An article on the recommended treatment or non-treatment would be useful.

Posted By Robyn Kuroki / Posted At 6/1/05 5:39 PM