Diagnosing your nail:

Initial visits typically consist of performing a biopsy of the nail to definitively diagnose the presence of fungus.  This is non-invasive and typically non-painful – it takes only a minute to complete and a few weeks to get results from the pathology lab.


Once the results are available, if the nail sample demonstrates fungal infection, we can initiate treatment.

  • Topical therapy: We recommend a topical nail solutions which is applied to the nails twice daily.  The antifungal solution we offer at our office is called Tolcylen.  Weekly use of emery board to the top of the affected nails is recommended for optimum penetration to the nail and nail bed.  Tolcylen has the active ingredient tolnaftate.  In some cases, Kera Nail Gel is recommended to aid in thinning the nail.  It is a gel formulation of Urea which is an agent used to aid in thinning the nail.
  • Oral Therapy:
    • Multivitamins: These assist in nail health to promote optimal nail growth.
    • Lamisil: This is a prescription oral antifungal treatment that is taken once daily.  The body metabolizes Lamisil through the liver and this requires monitoring of liver enzymes to ensure your liver is healthy.  Monitoring liver enzymes is done with a blood test.
  • Cosmetic Options:
    • Dr.’s Remedy is a line of polishes that come in great colors and are healthy for the nails.  This polish contains natural antifungal agents such as tea tree oil and wheat proteins.  Dr.’s Remedy also offers a wonderful polish remover that contains no harmful acetone!

Treating the environment that has predisposed your toenails to fungal infection is vital in preventing re-infection or spread of the fungus to adjacent nails or the skin on the feet.  We offer two primary options that meet this need.

  • Tolcylen Antimicrobial Spray: This spray that is used in shoes to decrease the microbial load within the shoes.  It contains colloidal silver which is a natural antimicrobial and undecylenic acid which is antibacterial and antifungal. The spray can be used in all shoes in the household and actually improves the smell of shoes due to decreasing the bacterial load present within them.
  • Steri Shoes: This product uses ultraviolet light to sterilize your shoes.  This comes as a pair to treat 1 pair of shoes at a time.  The device is spring loaded and this activates the light to turn on.  The device automatically shuts off at the end of a 45 minute cycle.  It is recommended that all shoes are treated initially and thereafter the pair of shoes worn during the day are treated that night.

If the nail sample does not demonstrate a fungus, there are still options to improve the appearance of your nail.

  • Keryflex is a cosmetic option to cover and conceal damaged nails with the application of a resin.  This takes about 20 minutes to apply and it is recommended to be replaced every 4-6 weeks for best results. If this is of interest to you, your doctors at PPFAC can provide the information you need to find someone specializing in applying this.
  • Kera Nail Gel: A 47% urea gel applied to nails once a day helps to soften thick nails and in some cases help grow in a more manageable thickness.