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.
[posted 08/6/2000]
Question: from 1996,I have some white spots on my face specially around my eyebrows.they appears in spring or summer & gradually disappear on autumn.after my delivery ,2 years ago some white spots appeared on my breast & they have not disappeared till now.sometimes I feel itching.everytime I become angry or sat these spots grow up.so what is this illness & what must i do?
Answer: Hard to tell without seeing them, but probably Tinea Versicolor.This is a low grade fungal infection of the skin that appears on the upper trunk and face due to the higher temperature there. Treated with topical antifungal creams etc. applied to the "white" areas for 4-6 weeks. Ensure you treat them for 2-3 weeks after the areas vanish to ensure that the fungus is killed throughout the depth of the dermis.
[posted 04/4/2000]
Question: I am a U.S. Marine who has a rather severe case of toenail fungus. It is only on my big toe of my left foot, but it has recently spread to the next toe. It is painful because of the deformity it causes (elevated nail is very sensitive). A Navy Doctor prescribed Lamisil 500MG per day for one week, repeat for four months. This is different from the way all other doctors seem to prescribe the medication... I questioned my Doc, but he seemed to not appreciate the question... is this an okay way to prescribe? Is it safe, relatively speaking? Any info would be GREATLY appreciated.
Answer: Yes, but this type of drug often will not fix the problem when dosed in this manner. Sporonox will, ask him to switch to sporonox instead, this has been documented as effective with sporonox(not lamisil). You will need occasional liver function tests and it will take a minimum of six months to fix(often one year).
[posted 08/31/1999]
Question: Terbinafine hydrochloride 1% cream is now available over the counter for athlete's foot, ringworm, and jock itch, but the package instructions specifically discourage use on the scalp or nails. I know that a lamisil cream is sometimes prescribed for nail fungus, and suspect that if this topical application works well (the drug tends to concentrate in the nails, I believe), the manufacturer may not want to create over-the-counter competition for its prescription creams or pills. Alternatively, FDA may disapprove of powerful over-the-counter drugs that are used for long periods, as is necessary to eliminate a nail fungus. In any case, am I correct in assuming that risks to the liver, etc., should be much lower when applying a cream directly to affected nails than when dosing the whole body? (Some doctors apparently prescribe systemic terbinafine without any liver function monitoring at all.) Also, I note that an earlier posting about terbinafine called using it for skin fungus like "killing a fly with a sledgehammer," or words to that effect. Do you think the drug is too powerful to be used without physician oversight? The fungicidal power is otherwise appealing, given that so many fungus treatments fail because people quit too soon, as I have done in the past.
Answer: Although not an indication, most physicians use it for exactly this purpose. The potential for liver toxicity is pretty small if you don't have pre-existing problems with your liver and don't use it for long periods.
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.
Fungus
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.
Anti-Fungal
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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