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    Diagnosis and Management of Onychomycosis: Perspectives from a Joint Podiatric Medicine–Dermatology Roundtable

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    Genre
    Journal article
    Date
    2016-03-01
    Author
    Vlahovic, Tracey cc
    Joseph, Warren S.
    Scher, Richard K.
    Tosti, Antonella
    Plasencia, Jesse
    Pariser, David M.
    Markinson, Bryan C.
    Department
    Podiatric Medicine
    Permanent link to this record
    http://hdl.handle.net/20.500.12613/7283
    
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    DOI
    https://doi.org/10.7547/14-170
    Abstract
    Onychomycosis is a fungal infection, and, as such, one of the goals of treatment should be eradication of the infective agent. Despite this, in contrast to dermatologists, many podiatric physicians do not include antifungals in their onychomycosis treatment plans. Before initiating treatment, confirmation of mycologic status via laboratory testing (eg, microscopy with potassium hydroxide preparation, histopathology with periodic acid–Schiff staining, fungal culture, and polymerase chain reaction) is important; however, more podiatric physicians rely solely on clinical signs than do dermatologists. These dissimilarities may be due, in part, to differences between specialties in training, reimbursement patterns, or practice orientation, and to explore these differences further, a joint podiatric medicine–dermatology roundtable was convened. In addition, treatment options have been limited owing to safety concerns with available oral antifungals and relatively low efficacy with previously available topical treatments. Recently approved topical treatments—efinaconzole and tavaborole—offer additional options for patients with mild-to-moderate disease. Debridement alone has no effect on mycologic status, and it is recommended that it be used in combination with an oral or topical antifungal. There is little to no clinical evidence to support the use of lasers or over-the-counter treatments for onychomycosis. After a patient has achieved cure (absence of clinical signs or absence of fungus with minimal clinical signs), lifestyle and hygiene measures, prophylactic/maintenance treatment, and proactive treatment for tinea pedis, including in family members, may help maintain this status.
    Citation
    Vlahovic TC, Joseph WS, Scher RK, et al. Diagnosis and Management of Onychomycosis Perspectives from a Joint Podiatric Medicine-Dermatology Roundtable. J Am Podiatr Med Assoc. 2016;106(2):155-62. doi:10.7547/14-170
    Citation to related work
    American Podiatric Medical Association
    Has part
    Journal of the American Podiatric Medical Association, Vol. 106, No. 2
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    ae974a485f413a2113503eed53cd6c53
    http://dx.doi.org/10.34944/dspace/7262
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