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Update on Onychomycosis:
Effective Strategies for Diagnosis and Treatment

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A CME-Certified Supplement to Skin & Allergy News

A CME-Certified Supplement to Family Practice News & Internal Medicine News



Jointly sponsored by:



This activity is supported by an educational grant from:

 Medicis, a division of Valeant Pharmaceuticals




David Pariser, MD, Chair

Professor of Dermatology
Eastern Virginia Medical School
Department of Dermatology
Pariser Dermatology
Norfolk, Virginia

Boni Elewski, MD
Vice-Chair for Clinical Affairs
Professor of Dermatology
University of Alabama School of Medicine
Birmingham, Alabama

Phoebe Rich, MD
Clinical Adjunct Professor of Dermatology
Oregon Health Science University
Portland, Oregon

Richard K. Scher, MD
Clinical Professor of Dermatology
Weill Cornell Medical College
New York, New York

Topic Highlights

  • The Rationale for Renewed Attention to Onychomycosis
  • The Epidemiology, Etiology, and Pathophysiology of Onychomycosis
  • Diagnosis, Clinical Implications, and Complications of Onychomycosis 
  • Current and Emerging Options in the Treatment of Onychomycosis
  • Promoting and Maintaining or Restoring Healthy Nails: Practical Recommendations for Clinicians and Patients

Target Audience
This continuing medical education activity has been developed for dermatologists, dermatology residents, dermatology healthcare providers and primary care physicians who treat diseases of the skin.

Educational Needs
Onychomycosis has become recognized as an infection of clinical importance well beyond its cosmetic effects. This is especially true for elderly individuals, patients who are immunocompromised (eg, because of post-transplant immunosuppressive drug therapy or HIV infection), and those with diabetes. The number of patients who present with onychomycosis has grown substantially as these high-risk populations increase, with increased longevity, greater survival among people with HIV infections, and the growing prevalence of diabetes mellitus. Clinicians must be prepared to make a clinical diagnosis of onychomycosis based on physical examination and personal and family history. The current standard of care is definitive diagnosis using recognized laboratory methods for identifying the presence of causative organisms. This supplement provides up-to-date information on epidemiology, pathophysiology, and diagnosis of onychomycosis, and reviews and provides expert recommendations on the currently available systemic and topical medications and devices for treating this infection.

Learning Objectives
After participating in this continuing medical educational activity, clinicians should be able to:

  • List and describe the differential diagnosis of onychomycosis and the expert-recommended methods for establishing the diagnosis of this infection.
  • Explain the benefits of early diagnosis and treatment of onychomycosis and the potential sequelae if this infection is untreated or is inadequately treated.
  • Apply practice protocols for identifying patients with onychomycosis, particularly the elderly, patients with diabetes mellitus, and other high-risk populations.
  • Integrate effective, office-based diagnostic tests into the workup of patients with symptoms of onychomycosis.
  • Use currently available oral and topical medications to treat various patient populations.
  • Evaluate the results of clinical studies on new and emerging treatments for onychomycosis.

As a sponsor accredited by the ACCME, the University of Louisville School of Medicine must ensure balance, independence, objectivity, and scientific rigor in all its sponsored educational activities. All faculty participating in this CME activity were asked to disclose the following:
1. Names of proprietary entities producing health care goods or services—with the exemption of nonprofit or government organizations and non–health-related companies—with which they or their spouse/partner have, or have had, a relevant financial relationship within the past 12 months. For this purpose, we consider the relevant financial relationships of a spouse/partner of which they are aware to be their financial relationships.
2. Describe what they or their spouse/partner received
(eg, salary, honorarium).
3. Describe their role.
4. No relevant financial relationships.

CME & PD Advisory Board Members: have no relevant financial relationships with any commercial interests: Lisa J. Pfitzer, MD; Soon Bahrami, MD; Douglas Coldwell, MD, PhD; W. Daniel Cogan, Ed.D., FAODME; Justin L. Costa, MD; James Creg; Daniel Da Justa, MD; Adair Heyl, PhD; Christopher Jones, MD;Lucy Juett, MS; Gerald Larson, MD; Rana Latif, MD; Kimberly Moore; Karen Napolilli; Scott Plantz, MD;Kerri Remmel, MD, PhD; Michael D. Stillman, MD; Uldis Streips, PhD; Kathy M. Vincent, MD; Lori Wagner, MD; Angela Wetherton, MD; and Stephen Wheeler, MD have no relevant financial relationships with any commercial interests.

CME Reviewer: Timothy Brown, MD, Professor, Division of Dermatology, University of Louisville, School of Medicine has no relevant financial relationships with any commercial interests.

Boni Elewski, MD, has been an investigator for Anacor and Valeant Pharmaceuticals.

David Pariser, MD, has been a consultant and/or investigator and/or advisory board member with Abbott Laboratories, Amgen, Astellas Pharma US, Inc, Basilea, Celgene Corporation, Dow Pharmaceutical Sciences, Inc., DUSA Pharmaceuticals, Inc., Eli Lily and Company, Galderma Laboratories, L.P., Genentech, Inc., Graceway Pharmaceuticals, LLC, Intendis, Inc., Janssen- Ortho Inc, Johnson & Johnson Consumer Products Company, LEO Pharma, US, Medicis Pharmaceutical Corporation, MelaSciences, Novartis Pharmaceutical Corporation, Novo Nordisk A/S, Ortho Dermatologics, Peplin Inc., Pfizer, Photocure ASA, Proctor & Gamble Company, Stiefel a GSK company, and Valeant Pharmaceuticals International.

Phoebe Rich, MD, has been a principal investigator and/or consultant for Valeant, Dow Pharmaceuticals, Topica, and Tolmar.

Richard K. Scher, MD, is an advisor/consultant to Valeant.

Joanne Still, BA has no relevant financial relationships with any commercial interests.

Sylvia H. Reitman, MBA and Shirley V. Jones, MBA, Global Academy for Medical Education, have no relevant financial relationships with any commercial interests.

ACCME Designation Statement
The University of Louisville School of Medicine designates this educational journal for a maximum of 2.5 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The authors would like to thank Global Academy for Medical Education and Joanne Still for assistance with the preparation of this supplement.

University of Louisville CME & PD Privacy Policy
All information provided by course participants is confidential and will not be shared with any other parties for any reason without permission.

Term of Approval: June 2013 - June 30, 2015





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