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Toenail fungus over 2 nails, nail not responding to laser treatment - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Infections
Answered by

General & Family Physician
Practicing since : 2004
Answered : 1722 Questions
User :   I have toenail fungus - my Dr. is treating it with laser treatments. There are 2 nails affected. One nail is responding, the other is not. For the nail that is not responding, does it ever work to completely remove the nail and then let it grow back?
Doctor :   hi
User :   Hi
Doctor :   Dr.XXX here.
User :   XXXXXXXX here
Doctor :   if there is infection associated or loss of blood supply to nail bed, then the nail may not respond to treatment
Doctor :   and the best that can be done is to get it removed
User :   What happens when the nail is avulsed (sp?) - Removed?
Doctor :   after removal of infected nail and complete treatment, new nail formation mighth happen and you will get new nail
Doctor :   if the blood supply is however affected, then the growth may not happen.
User :   Meaning, that the nail will not grow back at all?
User :   It seems to be growing very slowly, but the nail appears to be thick.
Doctor :   ok, then thickness can be attributed to the fungal infection, the growth retardation could also be du eto the same
Doctor :   I meant to say that of the blood supply to nail bed is not affected, then the growth will happen after removal
User :   Is there a way to test the blood supply, or to otherwise know that is what is happening?
Doctor :   yes, a careful examination done by your treating doctor to look for blood supply can be done
Doctor :   you can request for it in your next visit
Doctor :   Doppler scan for the affected finger will also help to see if blood supply is adequate.
User :   The treatment process leaves much to be desired. I tried a few rounds of Terbinafine treatment, but it has risk of kidney failure. Now I am trying the laser treatment. That is basically nothing other than focused heat. So it looks like that is only partially successful also. All of these are costly, and time consuming for the patient.
User :   OK. Let me get back on track.
User :   So, if the blood supply is inadequate, then the nail will not grow back. What is your opinion as to the best course in that case - for cosmetic purposes?
Doctor :   as I explained earlier, the examination and tests can be done to see if the blood supply is fine, and then you can decide upon the removal.
Doctor :   do you have diabetes or hypertension associated?
User :   No
Doctor :   ok, then chances of damage to blood supply is less. It is likely that it will be unaffected, which can be confirmed with doppler scan if needed
Doctor :   for cosmetic purposes, removal with regrowth of nail is best
User :   OK. My time is about up and you have been very helpful. Thank you very much for your help. Have a good day.
Doctor :   is there anything else I can help you with?
User :   No thank you.
Doctor :   thanks for consulting me. bye for now. wish you a great day ahead.
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