What is an effective alternative to oral medications or topical ciclopirox (Penlac) for onychomycosis?— Glenn Phillips, PA-C, Lake Forest, Calif.

Other topical agents that may be useful in the treatment of onychomycosis include 5% amorolfine (a morpholine derivative with fungicidal and fungistatic effect) nail lacquer and 1% bifonazole (Mycospor) with 40% urea ointment (for affected nail plate removal with chemical avulsion) ( J Eur Acad Dermatol Venereol. 1995;4:S3-S10).

Photodynamic treatment (PDT) uses a photosensitizer (a light-activated agent) to generate singlet oxygen and destroy microbial cells. Fungal nail infections caused by various dermatophytes have been successfully treated after repeated sessions with red light 5-aminolevulinic acid-mediated PDT (Photochem Photobiol. 2011;87:2-13). Lasers (predominantly Nd:YAG laser systems) have also been used to successfully treat onychomycosis (J Drugs Dermatol. 2010;9:1109-1113).— Philip R. Cohen, MD (166-4)

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