Question
Greetings Dr.George-  Several years ago I snubbed my big toe.  The nail turned black and wanted to come off.  I went to the doc to have it removed.  Despite trying to keep it very clean- it looks like a toenail fungus that I CANNOT get rid off.  Most of nail is yellow & thick.  I've tried tons of OTC treatments, but nothing works.  I heard there is a prescription I could get from a doc, and it would finally go away with taking pills.  Is this true?  Or is there some OTC that REALLY works?  Any advice you can offer me will be greatly appreciated.  Thank-you in advance for your kind time and help.  Have a great day.
Respectfully,
Susan

Answer
ANSWER: This Chicago, South Loop & Elmhurst Laser Podiatrist of AnklenfootCenters.com says.......

Dear Susan,

Laser for toenail fungus may be 65-89% effective-depending on the laser used & the technique of the doctor. Most patients need a second treatment & sometimes a third. Laser for toenail fungus is not covered by insurance and so make sure you get the total price of the treatment.  Make sure you get directions to prevent recurrence(e.g. not wearing same shoes for 2 days in a row-allow them to dry,drying toenails thoroughly,  before applying polish, etc)
If you take Lamisil- try to find a doctor who will do pulse dosing Lamisil-It works better and has less side effects.(off label-but works better & lots of good studies to validate)
Penlac and other topicals do not work-because they cannot penetrate the nail to kill the fungus.
Sometimes if the nail is removed-you can apply topicals to try to kill the fungus-but that is only used when the patient does not wish oral meds and does not wish to try laser treatment.You also need to gently file away he dead skin daily to allow penetration of the meds.
See your Podiatrist for the best management of your toenail fungus.p



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