Nail Fungus - Patients ask, Dr. Ringpfeil answers
Please feel free to use the blog below to share information about Nail Fungus or to ask Dr. Franziska Ringpfeil a question that might be of interest to others.
Philadelphia and Mainline Center of Dermatology and Cosmetic Surgery
Nail Fungus (Onychomycosis)
Onychomycosis is a fungal infection of the nail. Either fingernails or toenails can be affected but the condition is more commonly seen in the toenails. People become aware of the condition because of the altered appearance of the nail or multiple nails. The nail can become yellowed, crumbly, thickened, lifted up from the nail bed or debris can be seen beneath the nail.
DIAGNOSIS
A definitive diagnosis is made by clipping a portion of the affected nail and sending it to the lab for analysis. Other clues to the diagnosis include rash on the feet or between the toes consistent with athlete's foot (tinea pedis). Longstanding athlete's foot infection can put individuals at risk for toenail fungus. Fungal infection of the skin of the hands (tinea manuum) can also be associated with onychomycosis of the fingernails.
TREATMENT
One of the most efficacious treatment options is treatment with an oral antifungal medication such as Lamisil. Fungal infection of the toenails requires treatment for a period of three months; fungal infection of the fingernails requires treatment for six weeks. Since the oral antifungals are metabolized through the liver, blood test monitoring of liver function is recommended when treatment for more than six weeks is required.
Another promising treatment alternative with a high percentage of effectiveness is treatment with the PinPointe laser. This laser can be found at some podiatrists' offices.
Topical treatment with antifungal solutions and creams is also available but treatment success is low and daily treatment for many months is required.
All treatments are hampered by the high recurrence rate for fungal nail infection. Even if treatment protocols are strictly followed and nail fungus is eradicated, there is a good chance that the problem will recur.
COPING
The dystrophic appearance of toenails infected with fungus can be improved through the use of topical keratolytics such as urea and by having the thickened nails filed down professionally by a podiatrist.
Hi,
I want to ask if medical treatment of nail fungus typically covered by insurance? And do you take Blue Cross Blue Shield PPO for such treatment?
Thanks.
The consultation visits that surround medical treatment for nail fungus are typically submitted to insurance. Coverage for the visits or the medications that are prescribed is determined by your benefit plan and depends on whether you have a deductible, co-insurance or co pay requirement. You should contact your customer service representative at Blue Cross Blue Shield if you do not know what benefit plan you have. Our office submits to Blue Cross Blue Shield.
Hi, do you treat finger nail psorias? If so, do you take Aetna insurance.
Thank you,
CJ
Fingernail psoriasis is still challenging. If you have widespread psoriasis and require systemic treatment, fingernail usually normalize with this treatment. If psoriasis predominantly affects fingernails and joint disease is not present or is not treated with reversing agents, effective treatment of fingernail psoriasis is limited to periodic injections of steroids into the nail matrix. Some people respond to fingernail psoriasis with narrowband UVB treatment. This is a route that can be explored if insurance covers it. It requires treatment three times weekly in the office for several weeks. We do participate with Aetna.
Do you have laser services for nail fungus available at your office? Are such procedures typically covered by insurance?
While we do not offer treatment for toe nail fungus, a few podiatrist in the greater Philadelphia area do. The treatment is not yet an insurance recognized benefit.