Lasers

I am unhappy with my situation.

My doctor took me off Terbinafine after 6 months saying that it simply did not work. He was correct, because it didn't. My nails did not really get any better. Had it been my decision I would have stuck with it because I did not feel bad from it and I want to do everything I can to fight this infection, even if we can't say if one particular part in a multi-treatment works at all. If it doesn's harm me, let me stick with it.

After that nothing much happened for a couple of months. But now things are getting worse.... My thumbnail is horrible, almost completely loose. It is uncomfortable and it is actually painful. This has never been painful before. There is a numbing sensation of pain where the loosened nail meets the finger. As of now, I still stick to my amorolfine nail lacquer once a week, and terbinafine cream every day. I dropped vinegar again because I suspect it may not be good for my nails (what do I know) and back to sodium benzoate. It feels more gentle on the skin and does not produce that tingling sensation that vinegar does, I don't know if maybe the vinegar has been too hard on the nail bed, actually helping the infection.


Lasers are quite hot at the moment (haha). PinPointe and Nomir claim extraordinary results with their laser treatments for onychomycosis. However, these treatments are yet to be proven effective in quality independent studies. Nomir with their Noveon foot laser expected approval from the north american food and drug-administration in 2009, but so far no luck as far as one can see on their webpage.

Pinpointe boast with extraordinary claims, and I think one should expect these treatments to be effective to some extent, because if they did not do anything whatsoever they should not be around still. However, we don't know HOW effective they are until scientific independent studies have been done to a larger extent. As of now the treatments are fairly new (a couple of years) and the claims should be taken with a grain of salt.


That being said, I would gladly try it out for 1000 US$ if it was available in my neighbourhood. It looks rather promising on paper, and if it is effective it has huge potential considering it is non-toxic and it does not demand much of the patient when it comes to long-term labor.... Stay clean and disinfect your clothes and shoes, sounds better than for example soaking your feet in vinegar for several minutes twice a day......

Other things in development

Another similar substance under development is TDT-067 by Celtic Pharma. A press release from 2009 can be viewed at http://www.drugs.com/clinical_trials/celtic-pharma-successful-outcome-phase-ii-trial-topical-onychomycosis-6910.html . The substance as described by the company itself:

"Innovative drug carriers called Transfersomes® have been developed for the non?invasive delivery of agents into or through the skin. Transfersome® preparations consist of complex lipid vesicles, which are able to cross the skin permeability barrier, the stratum corneum, driven by the transcutaneous water gradient. TDT-067 (terbinafine in Transfersomes®) is a novel, epicutaneously applied carrier-based dosage form of terbinafine in development for the treatment of onychomycosis of the toenail and fingernail."

This does not seem to work with nanoparticles but instead with various substances that should work as carriers, penetrating the skin and transporting terbinafine with it to the seat of the fungal infection. Sounds interesting, and is now in phase 3 trials.


IDP-108 is being developed by Dow Pharmaceutical Sciences and is in phase 3 trials. Little can be found about this one, but initial reports from the manufacturer looks good, for what that's worth. Remember that things may look extra good in the beginning. But then again, if it did not work at all, they would not keep investing in it.

Studies have been done on the tolerability of stronger terbinafine solutions, 10 % as opposed to lamisil cream that carries 1 % terbinafine, the study can be seen at http://www.clinicaltrials.gov/show/NCT00443898, although the results cannot be viewed there.



I will keep posting useful links and also provide more extensive info on the mentioned treatments and substances.

Nanoparticles to battle nail fungus

I spend quite a bit of time online gathering information on this topic. I am searching high and low for a new and more effective treatment, none seem to be on the market yet, although a couple of things are are under development, such as the NB-002 drug, by NanoBio corporation. You can read for yourselves here http://www.nanobio.com/Dermatology/Onychomycosis.html .

This substance apparently uses droplets of oil that are super-tiny, to put it mildly. It is nanotechnology we are talking about, and these nanoparticles are supposed to, due to their small size, be able to enter the skin through pores and follicles around the nail, carrying with them dissolved terbinafine.

This sounds good, since the number one problem is actually getting the drug to the fungus, which is in the nail bed, safely hidden behind the nail. Research so far looks promising. One must rememeber that the first studies on a new drug are always conducted by the producers themselves, so the results may be biased, but still, the results look promising. One study can be viewed at http://www.drugs.com/clinical_trials/nanobio-corporation-completes-interim-analysis-phase-2-clinical-trial-onychomycosis-3624.html .

Another one is here, and it reports on the cure rates:

http://www.newslettersonline.com/user/user.fas/s=563/fp=20/tp=37?T=open_summary,50032714&P=summary


This drug is in phase 3 trials, meaning testing on human subjects in a larger scale, and it is the last phase before hitting the pharmacies (in some cases it can be sold and used outside of the clinical trial environemnt even before ending phase 3 trials, but so far NB-002 cannot be obtained over the counter).



When it hits the shelves, if I am still not problem-free, I will give it a try.

New photos

So these are my nails as of today (ish. two weeks ago.).


My index finger has significantly more healthy nail than it had some time ago, that has improved. My 4th finger looks really bad, but is unchanged really. My pointer finger developed an elevated ridge on the side that was rather sharp, but after filing it down to nothing, letting it grow out, and cleaning out excess keratin from underneath it, it is now less elevated. No healthy nail seems to be growing out though. Also on the other side of the nail fungus has been starting to grow inwards.

The thumb is horrible. A couple of times it has grown out to its full length in the middle, only being loose to the sides, but I just need to bump into something to loosen it from the finger again. It has also started to look worse on one side, fungus has grown back all the way to the cuticle on one side now (Ok, so it originates from the nail bed, but you get the picture). The part of the nail that is loose and yellow, it is now closer to the nail bed on one side.

On the bright side: six months ago my nails grew out very deformed with sharp ridges in them, almost parralel to the direction they grew, from the side it looked like hills and valleys. This is gone now and they are growing without change in a slightly "swollen" fashion, a little bit up and then down to the fingertip again.

My thumb of course is quite deformed but has been worse.

As of now I treat my toenails sporadically with sodium benzoate but my focus in on the fingernails. I have started yet again using vinegar on these. The smell is not that bad, on the toenails it is out of the question since your socks and shoes get a most horrible odour. I apply it 2-3 times a day using a big syringe, pure vinegar.


I shift back and forth but I believe it is useful as long as I do it every day, so that the fungus continually lives in an unfriendly environment. I want to go back on oral terbinafine and combine it with other treatments but I might go online instead of going back to my doctor, he blankly said it does not work on me and we should not do it if it doesn't work.