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George Woodbury MD 2/24/2023

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Nail Fungus – also called Onychomycosis –  or Tinea unguum - is the growth of an organism within the fingernails or toenails – causing the nails to become thickened or opacified – or brittle and prone to fracture. Let’s take a look at Nail Fungus Treatment – my perspective being that of a Memphis Dermatologist with over 30 years of experience with Rosacea treatment. 8018: 1-901-753-0168;, with a focus on what’s new.


First, what causes Nail Fungal infections?

Nail fungal infections often start in childhood or adolescence with contact with an organism – either a mold or a yeast – in one’s environment – such as at the gymn, or when barefoot in the yard, or when in contact with a cat or a dog. A small piece of a fungus – called a conidium or spore – gets a chance to grow within a fingernail or toenail – resulting in the start of an infection. Dermatologists now know that any nail infections start with an untreated case of athlete’s foot that allows a fungus to enter into a nail. So getting athlete’s foot treated promptly can be helpful in preventing a nail infection.


What types of fungus cause nail infections?

The most common causes of nail infections are what are called “dermatophytic” fungus and yeasts, in particularly the common causes of athlete’s foot, or tinea pedis, including Trichophyton rubrum and Trichophyton mentagrophytes. Another common cause is Candida, a common organism that also causes may cases of vaginal yeast infection. Fungal infections are contagious between people, meaning that it’s important to ask family members if they also have similar symptoms.


What sort of testing is done to diagnose Nail infections?

Dermatologists often do a baseline test called either a KOH test or a Fungal Culture, to look at the cause of thickening of a toenail or fingernail. The fungal culture is generally more helpful because it allows a Memphis Dermatologist such as myself to look at the particular organism that may be causing the infection, which helps to guide which oral medicine to use to clear the infection. This fungal culture test involves having a scraping done on the area of nail thickening, then watching the fungal culture plate generally for thirty days, to check for growth of fungus.

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What can be done to for Nail infection treatment?

Dermatologists have a growing number of medications that are helpful in clearing most nail fungal infections. The general rule is that oral tablets or capsules are much more effective than creams or ointments. Treatment options extend from the traditional griseofulvin tablets (Gris-peg®) to terbinafine tablets (Lamisil® tablets), Ketoconazole tablets (Nizoral® tablets), Itraconazole capsules (Sporanox®), and Fluconazole tablets (Diflucan®), with my perspective being that of a Board-certified Memphis Dermatologist in Cordova TN since 1993, previously in Rochester, New York from 1991 to 1993. All of these therapies have to be continued for a minimum of three months to be effective, and sometimes for as long as 18 to 24 months. Dermatologists generally do blood tests before starting treatment to evaluate the ability of the liver to metabolize these medications, then every one to two months or so while on treatment.


Which oral medication works best?

We sometimes have to start with one medication, then to measure response to that treatment after 3-5 months, then sometimes to change course to another medication mid stream, if there is no response. Everyone responds individually better to one or another of the oral medications listed above.

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After 25 years of practicing dermatology, in 2016 I decided to establish a skincare products company  - Big River Silk Skincare™ Inc. – of which I am the President -  to manufacture and distribute organic skincare products for people going onto prescription therapies: AmberSoy™ Soap Gel and the GlycoShea™  Creams and Lotions. These products have been used for many years by thousands of acne patients in Tennessee and Arkansas, and they’re now available nationally.  For more on these products, go to


So if you or a family member has complexion issues or Acne Rosacea or Rosacea, consider getting a checkup from a Board-certified Dermatologist. My own Memphis Dermatology practice since 1993 has been with Rheumatology and Dermatology Associates, as a Cordova Dermatologist, in Tennessee ( or (1-901-753-0168). Or you can find a Dermatologist in your own neighborhood by going to the American Academy of Dermatology web site,, then plugging your zip code into the “Find a Dermatologist” tab.


George Woodbury Jr. M.D. (01/24/2023)

Board-certified Dermatologist George Woodbury MD, Cordova TN, on Acne Treatment Strategies, from antibiotics to retinoids to isotretinoin: 1-901-753-0168.  2/24/2023

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