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)

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical question, submit it here.