Magan Medical Clinic, Dermatology
We provide quality dermatology care with compassion. Our specialty is medical dermatology, including:
Note: Cosmetic treatments are not performed in Dermatology but instead by Magan’s Medical Aesthetics Laser Center.
If you have psoriasis or hair questions, Dr. Chiang possesses special expertise. He completed fellowships in both fields at University of California, San Francisco where he saw a wide spectrum of patients (including the most severe), performed clinical trials, and published research.
We take pleasure in serving our community including Covina, West Covina, San Dimas, Rancho Cucamonga, Baldwin Park, Azusa, Glendora, Upland, El Monte, Duarte, Monrovia, Arcadia, La Puente, and Diamond Bar.
Same day appointments often available. No referral is necessary if you have PPO insurance. We accept a wide range of insurance plans (unfortunately, we do not accept Medi-Cal as primary insurance, only as secondary insurance).
For appointments, please call (626) 331-6411. We look forward to serving you!
"What’s New in..."
A monthly column by Dr. Chiang
What’s New in Toenail fungus (onychomycosis)
Many patients come in for their toenail fungus, which manifests as yellow thickened toenails with “debris” underneath. The most effective treatment is taking an oral tablet called terbinafine (Lamisil) for 3 months. However, it does have risks including liver toxicity and taste loss.
For very motivated (in terms of seeking treatment within 1 year of the fungus developing, willingness to treat every day for 48 weeks, and be willing to pay likely high medication copays), the two newer solutions, either efinaconazole (Jublia) or tavaborole (Kerydin) seem to be reasonable alternatives. That being said, the majority of patients I see would likely not fulfill all 3 criteria, as most wait until they’ve had the condition for years, do not wish to do the somewhat time-intensive (it takes time to use the applicator to treat each affected toenail with several strokes to cover the nail, the lateral nailfold, the proximal nailfold, and the distal nailfold) treatment literally every day for 48 weeks, and often face large medication copays from their insurance company as there are not yet (and likely not for decades) generic equivalents for these branded medications.
In the past, I haven’t been that excited about these two medications due to the efficacy for those who’ve had the fungus more than a year still only being 16 to 17% even in those who do the daily applications for 48 weeks and pay the large copays (as a side note, patients often ask how much the copay will be. The doctor does not know, although can guess if it’ll usually be “low” or “high.” The pharmacy is the only one who can tell the patient the specific amount as they’re the ones charging the insurance company & dispensing the medication).
The patients I am somewhat excited to treat are those who say “I didn’t have any fungus a year ago” as a clinical trial showed for those with toenail fungus less than a year, the efficacy for efinaconazole solution once daily for 48 weeks is 43%. This starts to get in the range that it is a reasonable alternative to the oral terbinafine tablets. However, again, this still involves a time commitment and potentially high copays. It also still means there’s a 57% chance the fungus will not be cured (although potentially still improved somewhat).
The other additional work for patients that has been shown to increase their chances for toenail fungus cure is to also treat any coexisting foot fungus (tinea pedis). This would be another cream or gel, usually twice daily.
If you have toenail fungus, consider making an appointment for dermatology consultation at (626) 251-1500 to discuss your options.
Charles Chiang, MD, FAAD
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