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Dr. Nair
Dr. Nair, Dermatologist
Category: Dermatology
Satisfied Customers: 9136
Experience:  MBBS, MD (Dermatology, Venereology & Leprology)
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I have had a toenail fungus on my big toenail least

Customer Question

Hi I have had a toenail fungus on my big toenail for at least over a year and it is like a strip from top to bottom, probably takes up about 1/3 of the nail bed area.or maybe a little less. about a month it started to become discolored, dark colored like a bruise color pretty much where the fungus is. no pain or discomfort, not extremely dark in color. I work as an OT assistant and a Podiatrist that came to my nursing home a few years ago and gave me Formula 3 antifungal solution. I put it on my toenail distally where you could feel the fungus between the nail and skin. I think i should have covered the entire nail with the solution and I should do it for a long time. Could you please address my concerns. Thank you.
Submitted: 1 year ago.
Category: Dermatology
Expert:  Dr. Nair replied 1 year ago.
Hello,
Thank you for your question. My name is***** and I will do my best to provide a useful input.
Would a photograph of the affected area be possible at your convenience?
Customer: replied 1 year ago.
Hi Dr Nair, yes I could provide a photograph. I'm at work now so and it's 5:30am here in California. I could provide one around 1-2 pm thus afternoon. How do I send it? Thank you
Expert:  Dr. Nair replied 1 year ago.
That's fine, I'm on Asia time so will get back to you asap once I have seen it.
If you can transfer the photograph to your computer then the fastest way to get a picture to me is to upload it to the question box by clicking on the paper clip or tree icon in the question box toolbar. This toolbar does not display in google chrome and safari so an alternate browser may be required. You can also upload them to any free photo hosting site like picasa or photobucket and send me the link if you prefer.
Or you can email the photographs to***@******.*** with my name (For Dr Nair dermatology expert) in the subject line but they usually take a few hours to forward these to me. If you choose this option please make sure you ask for an acknowledgment from JustAnswer that they have received your mail, and let me know that you have sent it. Please note that you must send this from the same email address you registered with justanswer.
Customer: replied 1 year ago.
Ok Dr. I think I will try the easier of the 2 ways, I'm not too good at sending pics. It may be later today, I don't have access to my computer. Is there any way I could take a picture from my phone and text or email it from there
Expert:  Dr. Nair replied 1 year ago.
Yes that's fine - you can email as per my instructions directly from your phone. Regards.
Expert:  Dr. Nair replied 1 year ago.
Good Afternoon,
Thank you for the photograph. Okay so the black spot could just be fungus or it could be a small bruise below the nail (nails with fungal infection get detached from the nail bed and are much more prone to trauma). The worry with such spots is that they can sometimes turn out to be melanoma.
Let me first address the nail fungal infection. Toe nail fungus (Onychomycosis) is best treated with oral antifungals like terbinafine and itraconazole and these require a prescription. The dose is 250 mg once a day for 12 weeks for terbinafine and itraconazole 200 mg twice a day for 7 days (1 week) for 3 consecutive months, or 100mg twice a day daily for the same duration. The success rate is moderate but can be further improved by using a ciclopirox or amorolfine nail lacquer on the affected nail for 6-12 months.
If only one nail is affected as in your case then complete nail removal along with laser removal of the underlying debris followed by topical antifungal therapy is the treatment of choice in patient’s who cannot tolerate oral antifungals or don't want to take them for any reason. In your case I would recommend this since this would also enable direct visualisation of the black spot and a biopsy from it if required.
Please feel free to ask if you have any queries. I will be happy to continue further and do everything I can to provide you with the service you seek.

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