Brief Answer:
I need further history of the disease and pictures of toenails.

Detailed Answer:
Once again Dr. Hanif warmly Welcomes you back!

Good afternoon & hope weather is good in Ohio. I have thoroughly gone through your issues related to toenail fungus, and can realize your health worries. Being your physician, I assure you not worry at all as I will take care all of your medical concerns.

As far as toenail fungus is concerned, I need to ask you:-
* Does your shoes pinch you anywhere at feet?
* Are you a known diabetic, and/or hypertensive?
* During most of the day, which shoes you wear i.e joggers, slippers etc?
* Do you ever felt pain, changed sensations, discomfort in feet in general, and in toenails in special?
* Do you have fungal infection anywhere in the body, like groin, scalp or elsewhere?
* List any medications which you are taking right now for any reason and any known medication allergy?


I am waiting for your reply including answer to the above questions, and pictures of both the nails (try good resolution and clear pictures). There are different forms of fungal infection involving toenails. So, treatment and care for such infections becomes more focused and effective if I will examine the pictures first with complete history in front of me.

You may attach pictures directly from this question window, or simply email them to YYYY@YYYY with the Subject as, Attention:Dr. XXXXXXX Hanif, and the images will directly reach my inbox for review.


Have a wonderful day ahead.


Regards!
DR. XXXXXXX HANIF
USA

---

Brief Answer:
Onychomycosis (toenail fungal infection). Treatment is suggested.

Detailed Answer:
Dr. Hanif, your physician, welcomes you back!

I really appreciate the efforts you made to manage uploading the pictures. Your cooperation is highly appreciated and I assure you, your fungal infection will go away, with continuous treatment and proper care.


Looking at the pictures, it seems to be a typical case of a type of fungal infection caused by Trichophyton rubrum which accounts for more than 72% cases of fungal infections of the nails. You are serving in army, so let me add that this fungal infection has migrated in the recent decade from XXXXXXX and Asia, and Army men travel most of the parts of the world. The disease has typically attacked your toenail outer edges, which is the area that continuously gets trauma from hard shoes of Army officials like you.


Such conditions need consistent and targeted treatment. Mostly at my clinic I start my patients with topical antifungal agents. But, if I see that after weeks of treatment it isn't working anymore, and the disease is that much advanced, I add oral antifungal agents too to expedite the recovery.


If I was your treating physician, I would preferably have started you with topical antifungal agents, as it will work very fine for you. According to my expert opinion, your severity scale for fungal infection (OSI Score) falls in mild-to-moderate disease category.

Treatment:
* Ciclopirox olamine 8% topical nail lacquer at night (don't wash until morning);
Plus
* Tavaborole Solution during the day.

Note:
Apply both of them once daily, to completely cover the nail and under the tips of both the nails. This treatment may be needed to carry on for more than 40 weeks as fungal infections are very tough ones to treat especially when it comes to the nails. We have to penetrate the drug through all of the nail layers. That's why I have added Tavaborole that has a good penetration power.

Though chances are rare, but if you feel, nothing is working good enough, please consult a podiatrist for complete in-office evaluation and treatment plans. May be surgical intervention or chemical avulsion is needed.

As I asked you in my previous answer, I refer you to your physician for some blood work, just to make sure everything is fine. You may also request him for a prescription of the above medicines. Ask him to do HIV testing and Diabetes screening.

Stop all over the counter medications. Improve your diet with high protein content, vegetables, fruits and high fiber diet. Avoid fatty, spicy and fast foods. Avoid fitness activities, warm and humid environment, tight fitting shoes, longstanding usage of hard shoes. Change your socks daily and avoid sharing socks and shoes.

Have a wonderful time ahead. Hope I answered all of your questions. Let me know if you have any further clinical concerns. I will be happy to get back to you shortly. If satisfied here, please give a five star rating as you appreciably did previously too. Please don't forget to close the discussion.

Regards!
DR. XXXXXXX HANIF
USA

---