Well it’s a new year. And after a recent trip to a place full of exposed toenails, I have come to a few conclusions. First, the incidence of angulated toes, very flat feet, and colorful toenails in the general population seems to be quite lower than in my NYC podiatry waiting room. Second, I probably take note of said fact a bit too much and I don’t want to think about what other specialists notice in the general population. But back to our discussion of last year when life was simple and all was grand, what to do about those fungal toenails? New Year is off to a thrilling start so far…

As we previously discussed, those little fungal critters are pesky and difficult to eradicate, necessitating a method that penetrates through the gnarly nail plate down to the infected skin. The gold standard still remains the oral medication. However a few new methods of treatment with great outcomes and minimal side effects have emerged over the past few years. The first is the new generation topical medications that are applied directly to the nail. You may recall the lacquer that was previously available and was marginally effective. These newer medicines are much better, and of course, more expensive. The medicine is essentially brushed onto the affected nails daily for a period of 48 weeks, and as it penetrates through the nail plate, the fungus is eliminated- in most cases. The downsides are the length of treatment and widespread coverage resistance among payers (insurance company denying treatment? I’m shocked, shocked!). Another relatively new treatment, which is available in your own NYC podiatry office, is laser therapy, a painless and effective method of treating nail fungus, successful in about 80% of cases. This involves three office treatments, lasting about 20 minutes each, three weeks apart. And while the results are not guaranteed, the outcomes are generally good, without side effects or long treatment protocols. The downside of this treatment is widespread exclusion from any insurance coverage, so those healthy nails will come at a price, although without the need for pills or topicals.

That ends our lesson for today, my dear NYC podiatry patients. Remember it takes about 6 months for new healthy nails for grow, so if you want beach nails for the summer, now is the time to start planning. Yes, time does fly by. Now to make 4 years go quickly…

See you in the office.

Ernest Isaacson

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Ernest L Isaacson DPM PC
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