My interest was piqued after reading this article in Podiatry Management June / July 2016. Profiles in Excellence reports on Dr. Win's remarkable compound which promises to:

1. Cure the fungal nail quickly

2. Prior cleaning and debridement not necessary

3. Nail polish does not have to be removed

http://podiatrym.com/pdf/2016/6/WinlindProfile616web.pdf

Interested to know more and keen to ask some questions I e-mailed the company to ask:

1. Clotrimazole is not new. What is new about Dr. Win's formulation?
2. Dr. Win claims the active ingredient (1% Clotrimazole) is fungicidal. It is not, it is fungistatic. What data is there to support the claim?
3. Dr. Win explains all the disadvantages of antifungals but does not say how his is better.
4. Are the any RCTs to support the claims made?
5. What does the formulation have that others do not to miraculously penetrate nail without debridement and through nail lacquer. 
 
I got the following response:
 
1. Our product has been shown to be highly fungicidal ( see our website ) and to have good penetration  because of our proprietary formula.
2. The advantages are described in our website and the two linked Profile articles.
3. The  efficacy can be theoretically and soundly  predicted based on pharmacokinetics and pharmacodynamics  The predictions  are supported  from users as shown in true testimonials as well as comments many other users.
4.Dr. Berlin, a podiatrist and our distributor, has been quite satisfied with the clinical performance of our product.His website can be accessed to  from our website.
 
Unable to get better information I am curious to know what the readers might think. What is the magic 'proprietary' ingredient that claims to succeed, where so many other topicals simply do not fair so well. 
  • Comments (23)
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  • I received some information from Dr. Win L Chiou, about 'Dr. Win's Fungal Nail Treatment'.

    Dr. Win's e-mail offered little additional information to shed more light on the issues. I was asked to desist from publishing his e-mail and out of professional courtesy I have obliged. I will add that Dr. Win has impeccable professional credentials and appears genuine and sincere. 

    Dr. Win is now aware I also sent an invitation to contribute here last September. Dr. Win expressed the view that he has no interest in a public debate. That's his perogative, of course.

    I commend his (delayed) contribution but, as far as I am concerned, there's nothing new to change my mind here (yet). The basic underlying premise appears to be 'I am telling you it's good, so trust me' AND 'Other people are buying so it MUST be good'. To be fair, the void of definitive evidence is a short-coming not specifically peculiar to Dr. Win's formula. 

    As far as I am concerned, none of the contemporary, modern topical anti-fungals are much better - or much worse. The dense nail plate is the nemesis of the topical anti-fungal, no matter how well this might perform in-vitro. Can performance match the in-vivo challenge, and over a time frame less then 48 weeks? The topical anti-fungal industry is collectively and nonchalantly largely unconcerned, about this ridiculous burden put on a patient. How can we KNOW there is a superior solution to Terbinafine, Clotrimazole, Jublia etc etc. 

    BUT, here's my take: add the topical (whatever topical you prefer including Dr. Win's formulation) to nail trephination (forget Lasers- expensive, unreliable, and of questionable value) and AT LAST, you can have a REAL game changer.

     

     
  • Quote:

    Hello Dr. Feltner, I have heard of something like the clearanail system, but didn't know it was available. How much did you buy it for? How much do you charge to do the clearanail procedure for a patient? It's a once a year procedure I gather depending on nail growth? I order Clarus directly from Bako lab. My assistant does the ordering, we may get a lower price for ordering a certain amount. I am unsure. I sell Clarus a lot, at least 10 bottles a week. There is also Clarus antifungal cream which is tolnaftate, tea tree oil and urea. That seems to be a harder sell for some reason. If the clearanail works I'd be interested. Onychomycosis is biggest complaint I hear as a podiatrist.


    Dr. Dale:

    I am a huge fan of any technological advance that can help and contribute to optimizing a treatment. The painless introduction of multiple micropores in the nail-plate is a significance advantage when combined with effective topical anti-fungal medication. It's likely several of the available agents are very effective in-vitro but crossing the nail plate barrier in-vivo often-time presents a significant challenge. Pretty much all of the proprietary medications carry the caveat of the potential for a 48 week treatment cycle for the toe-nail. When a patient is concerned about systemics, this is especially a very viable alternative. 

    ps I have sent you a private message

  • Hello Dr. Feltner,

    I have heard of something like the clearanail system, but didn't know it was available. How much did you buy it for? How much do you charge to do the clearanail procedure for a patient? It's a once a year procedure I gather depending on nail growth?

    I order Clarus directly from Bako lab. My assistant does the ordering, we may get a lower price for ordering a certain amount. I am unsure. I sell Clarus a lot, at least 10 bottles a week. There is also Clarus antifungal cream which is tolnaftate, tea tree oil and urea. That seems to be a harder sell for some reason.

    If the clearanail works I'd be interested. Onychomycosis is biggest complaint I hear as a podiatrist.
  • Quote:

    I give patient's clarus topical solution from bako labs which is tolnaftate antifungal with menthol and essential oils to help the tolnaftate penetrate the nail.  I've had more luck with this than any other topical antifungals I've tried.  Jublia and Kerydin are statistically and clinically better in my experience, but it's getting harder and harder to get that approved by insurances at least where I am.  I sell clarus for twice price I purchase it for which is $18 for patient cost.  

    I agree too about trying patients on PO terbinafine if possible.  I tell patients to file nails at least once a week while applying topical antifungal to keep nail thin to help the topical work more effectively, spray shoes out once a week with lysol to prevent reinfection from fungus material in shoes.  I also take a picture of patient's toenails before and during treatment of the onychomycosis.  Applying topical antifungal on all toenails, even ones that don't look fungal, is recommended I read in article once because there may be fungus we can't see visually on some nails.

    Dr. Dale,

    Thank you for sharing your clinical experiences with anti-fungal treatment options. In our patient population (Bronx) it was difficult (almost impossible) to have insurance approval, even for Clotrimazole. Jublia and Kerydin are definitely out of the ballpark.

    I note that Clarus (15ml) can be purchased from Amazon for $42.00. If your patients get the same product & quantity for $18 that's a great saving.

    I recently changed office location and purchased the Clearanail system. This promises to reduce dramatically treatment time for a patient. With this system an alcohol based anti-fungal spray is preferred for penetration.

  • I give patient's clarus topical solution from bako labs which is tolnaftate antifungal with menthol and essential oils to help the tolnaftate penetrate the nail.  I've had more luck with this than any other topical antifungals I've tried.  Jublia and Kerydin are statistically and clinically better in my experience, but it's getting harder and harder to get that approved by insurances at least where I am.  I sell clarus for twice price I purchase it for which is $18 for patient cost.  

    I agree too about trying patients on PO terbinafine if possible.  I tell patients to file nails at least once a week while applying topical antifungal to keep nail thin to help the topical work more effectively, spray shoes out once a week with lysol to prevent reinfection from fungus material in shoes.  I also take a picture of patient's toenails before and during treatment of the onychomycosis.  Applying topical antifungal on all toenails, even ones that don't look fungal, is recommended I read in article once because there may be fungus we can't see visually on some nails.

  • It is now three weeks since Dr. Win was invited to comment. In light of this noteworthy absence of a contribution the reader can draw their own conclusion.

  • By way of a fair & balanced perspective, I have e-mailed the link to this discussion to Dr. Win. I will welcome his contribution.

  •  


    Jublia was being advertised last year during NFL games. My guess is that it is being marketed as a cash product to vain, young or middle aged guys with early fungus or to their girlfriends with same or who want their guys to be rid of that ugly, disgusting stuff. Not to Medicare folks who won't spend more than 30 bucks or so out of pocket (in my area, generally) for a non-life threatening condition.

    You know, if any of these companies fail it means little. The execs have taken their money already in huge salaries and bonuses for sure. The stockholders who don't get out early enough wil be screwed, that's all. 


    Jubliauhm .... yes, I'm quite amazed anyone might be persuaded to part with top $$$ when there are alternatives - all of the topicals carry the 48 week treatment caveat. How does a company swing such a feat? Good marketing? Good research? Bad advice from their healthcare provider?

    Or simply sublime BS?


  • Jublia or Kerydin might be worth a shot. My understanding is that Jublia is not covered by insurance, for the most part? A brief search suggests at over $540 this drug will have to outperform Terbinafine (circa $10-$20), by a substantial margin. Kerydin cost isn't that much different at around $ 530 for 4ml.

    How are these companies selling any of those products at that price?

    (c.f EpiPen)

     


    Jublia was being advertised last year during NFL games. My guess is that it is being marketed as a cash product to vain, young or middle aged guys with early fungus or to their girlfriends with same or who want their guys to be rid of that ugly, disgusting stuff. Not to Medicare folks who won't spend more than 30 bucks or so out of pocket (in my area, generally) for a non-life threatening condition.

    You know, if any of these companies fail it means little. The execs have taken their money already in huge salaries and bonuses for sure. The stockholders who don't get out early enough wil be screwed, that's all. 

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