The Skin Center

26081 Merit Circle Suite #109
Laguna Hills, CA 92653
(949- 582-7699
(949) 582-SKIN
Fax (949) 582-7691

“A Fungus Among Us”

Program for Fungal Nail Infections (Onychomycosis)
Fungal Nail Infections (onychomycosis) are very common and account for about half of all nail diseases. Although onychomycosis is very treatable, it may be resistant and difficult to clear fully. A variety of oral (pills) and topical medications are available to help clear fungal infections. Once in the nail bed, fungus requires a short 2-4 month course of oral antifungal medications to clear. Although there are possible side effects with any medication, most of the oral antifungals can be safely used with proper medical monitoring and lab tests before, during, and after therapy with these pills.Most common side effects are liver abnormalities. Monthly visits are required along with regular monthly lab tests during the 3-4 months of oral antifungal therapy. We have developed a unique program utilizing a team and combination therapy approach to this problem. Since overall cure rates with topical antifungals if used consistently for 12 months range anywhere from 5-15%, most patients prefer higher cure rates of 50-85% with oral therapy. Our center has found greater cure rates and longer remissions with our combination approach of topical and oral treatments. Treatment is particularly useful for those with a history of diabetes and or recurrent infections of the feet or groin from the fungus. Not all nail fungus requires treatment.

Our office confirms fungal nail infections with proper lab tests like a fungal culture or nail biopsy. All patients must have a normal set of screening labs within a few months before starting antifungal medication. Most patients will take a 2 month daily dose of oral Lamisil for fingernail infections or 3 months if they have toenail infections. Alternatively, patients may take two Sporanox pulses ( one week of pills / month) for fingernail fungus and three sporanox pulses for toenail infections. Some patients with resistant, recurrent, or diabetic complicated disease may require slightly longer courses of pills. Fingernails grow out in about six months. Toenails are slower growing, and take about 12 months to grow in fully. The nails continue to improve even after you have stopped the oral antifungal pills.

The goal of your therapy with antifungal therapy is to clear skin and nail fungal infections and cut down on your chance of spreading it to your family and others. Since people with fungal infections are inherently more prone to future recurrences, it is important to have a prevention and maintenance plan after the fungus has been cleared.

The Skin Center
949-582-SKIN or (949) 582-7699


1. Wash feet and between toes in the shower with
Nizoral Shampoo / Loprox Shampoo
once a day Once a week Twice a week three times a week

2. Apply under each affected nail
Fungoid Tincture /Loprox Suspension
once a day AM twice a day

3. Apply Penlac Nail Laquer over (on top of) each affected nail once a day PM
( wipe off once a week with rubbing alcohol)

4. Sprinkle Pedi-Dry foot powder into all shoes
as needed once a day Once a week Twice a week

5. Take oral antifungal for nail infection
Lamisil once a day for three month
Sporanox 2 capsules twice a day for 1 week & then stop ( called a “pulse”)

6. Apply Urea cream or spray to soften thick nails / or on calluses soles
once a day Twice a day

7. Apply Lamisil spray or cream/Ertaczo cream/Loprox suspension to soles and between toes
once a day twice a dayas needed

8. Always dry feet and spaces between toes after showers

9. Trim nails and keep them short. Remove all yellow thick debris with nail clippers.

10. Take all of your own instruments, nail file, etc to all nail salons. Do not soak in their tubs unless you are certain atleast 10-15 minutes of cleaning has been done between clients.

11. Return for your re-check in 1 month AFTER you start medications.

12. If you are having a lot of trouble, side effects, or an allergic reaction , stop treatment immediately and then call us for an ASAP appointment. STOP ALL MEDICATIONS IMMEDIATELY IF YOU DECIDE TO BECOME PREGNANT OR THINK YOU MAY BE PREGNANT. Please read your antifungal brochure. Call for any questions (949) 582-SKIN or (949) 582-7699.
Call to Schedule an appointment at (949) 582-SKIN 
Dr. Gary Cole and Dr. Nili Alai are Board-Certified Dermatologists.
For more information, please call (949) 582-7699 or visit the practice website at

Information in this publication and site is not intended to serve as medical advice. Individuals may use the information as a guide to discuss their treatments with their own physicians. This site does not promote nor endorse the unauthorized practice of medicine by non-physicians or state licensed health care providers.

Medicine is a constantly changing science and not all therapies are clearly established. New research changes drug and treatment therapies daily. The authors, editors, and publisher of these articles have used their best efforts to provide information that is up-to-date and accurate and is generally accepted within medical standards at the time of publication. However, as medical science is constantly changing and human error is always possible, the authors, editors, and publisher or any other party involved with the publication of this article do not warrant the information in this article is accurate or complete, nor are they responsible for omissions or errors in the article or for the results of using this information. The reader should confirm the information in this article from other sources prior to use. In particular, all drug doses, indications, and contraindications should be confirmed in the package insert.