Practice News

August 2015

JUBLIA: New Prescription Topical 

You probably don't remember the ad in the last Super Bowl against the Patriots and the Seahawks with the little toe man in the boxing gear. It was an ad for Jublia. Launching last year with a very well-funded ad campaign, yes even including a Super Bowl spot, Jublia hopes to capture the void in the market left by the failure of laser nail care. There has always been this search for the "Holy Grail" of fungus nail treatments where a company tries to find a product that is not an oral medication but actually works. Laser was a bust. Will Jublia (or its competitor Kerydin: that varies only from a technical, pharmacologic difference) be the one? Maybe. It seems to work well for early, minor cases of onychomycosis. The difficult thing to tell is how much better than over the counter antifungals it might be. I have been following the effectiveness of these agents for about a year now. Results are starting to be observable in the real world of clinical practice. I have seen some obvious cases of clearing nail. The prescription is exceedingly expensive and private insurance is not, as a rule, covering costs, so the companies are heavily subsidizing the purchase with various coupon programs. These marketing schemes will not be around forever, so now would be the time to try. Remember, these agents are not for moderate or heavy nail involvement. Oral therapy is still the best option for advanced cases.

August 2015

THE POST MORTUM ON LASER NAIL CARE

[Dr. Passeris' note: Please note: The website recently updated and in doing so a long stream of blog entries in this thread were lost, except the initial one from 2010 seen below. These discussions described my obeservations regarding Laser Nail care. Frustratingly, there is no way to recover all that information, but the over-riding theme was that I was skeptical about the effectivness of Laser treatments for fungal nails and I remain so. in 2012, I performed my own small clinical trial in office, a total of 12 patients, and the results were no observable change in any of the treated patients after 9 months. The following are my  opinions alone. I take complete responsibility for them.]

 

It has been awhile since my last update on the world of laser nail care. In that time the market has really run its course and gone to maturity as I knew it would. Laser  fungal nail treatments really began in and aroound the year 2008 in the Bay Area. Fads come and go in the world of foot care  and this one certainly had aggressive artificial promotion by the desperate adherents, the foot doctors trying to pay for their new machines. But over time, because of the uselessness of this treatment, it has faded into the dust bin of podiatry and has been added to the grave yard of all the other useless treatments foisted on the American public. This is not to say that you can't still get this treatment, you can. Especially in some markets in the U.S. like New York/ New Jersy and L.A. And it’s not to say that you don't still hear the occasional radio ad or see the print ads. You do. But the radio spots are now non prime-time and are rare, and the print ads are back-page and small. One podiatrist I know in the City, recently asked me to share the use of his machine so I could help him recoup his costs for the laser. (Of course, that’s not how he put it. He tried to convince me how well it works) Remember these machines cost in the neighborhood of seventy thousand dollars. Further, the ads in our trade journals, though still present, are down to one or two vendors from a plethora, and they are promoting all skin treatments as much as they are promoting their use for fungal nails. At the last annual scientific conference held this past June in Anaheim called, "The Western Foot and Ankle Conference", a major national seminar, there were exactly zero scientific presentations or updates on this treatment. This is the same as prior years. The final data on this topic  has always been heavily biased towards the sponsors of the research, those being the manufactures of the lasers. Their studies were always very impressive with great before and after results. The trouble is this just hasn't manifested in the community at large. Suffice it to say, no one has ever claimed that lasers could treat moderate to severe fungal nail infection, and in the very early and minor cases, actual bona fide onychomycosis usually clears with aggressive treatment of any kind, laser or no. The public has not supported this treatment and has grown weary of wasting their money on it and therefore is not demanding it. And so laser nail treatment has withered on the vine. To date, I have still seen no verified cures in my office practice. So, I’m done reporting on this topic.

 

MARCH 2010

Laser Fungal Nail Treatment: Dr. Passeri Discusses: Treatment Miracle or Bust?

We have been receiving many calls regarding advertisements for a new treatment for fungal nails involving laser. I have seen or heard these ads. Who hasn't!? Many patients ask me whether or not I provide the service.

No, I do not. I know very little about this so called treatment for fungal nails. Interestingly, the company that provides the laser did present to our yearly scientific seminar in the summer of 2008, but they were conspicuously absent from the 2009 meeting. Interesting because it takes about a year for a new, healthy nail to grow out, and a year after the roll out for the new treatment, the company had no information to report to us. To date, I have seen no one in my office who has had the treatment. So I have no first-hand experience of positive outcomes or failures.

I do know that the treatment is a one-time pass of the Laser costing $800-$1000. The wait time for results after the treatment is roughly a year. Of course it is not covered by insurance or Medicare, and of course there are no guarantees.

Until I get real data, from real long-term follow-up studies showing the effectiveness of laser, I will not be providing this treatment. Don't get me wrong, I think it would be great, but I remain very skeptical. I am not experimental with your health. I didn't start prescribing Lamisil for nails until I was sure of its effectiveness. I was probably 2-3 years later than many doctors, and I will use the same caution with this new treatment. Time will tell.

 

FEBRUARY 2010

Lamisil Goes Generic, Good News for Fungus Nail Sufferers

Lamisil (Terbinafine) has gone generic and is now much cheaper and available to everyone. After more than 20 years in the marketplace, Lamisil which used to cost over $1,000 for a three-month course of treatment for onychomycosis (fungus nails), now cost very much less possibly 1/3. It is affordable for everyone. Check with Dr. Passeri or your pharmacy. Chances are, if you've been waiting to be treated, you will be able to start that treatment for a very reasonable price.