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Pedi-Cure: For Latest Health Warning, Look Down

December 11, 1995

NEW YORK (AP) _ You’ve conquered gingivitis. You’ve overcome the heartbreak of psoriasis and you haven’t had a pimple since the ’60s.

But wait. Before claiming you’ve beaten all of life’s everyday health hassles, take a look at your big toe.

If the nail is yellowed and cracked or worse, if it’s rotting away, you may have toenail fungus _ a stubborn and painful infection that doctors say plagues 12 million to 35 million Americans, but is largely unknown even to many who have it.

Up until now, the only drugs that cured this close relative of athlete’s foot took 12-to-18 months to work and had a variety of side effects from headaches and nausea to a risk of hepatitis. As a result many doctors didn’t prescribe them. Many patients haven’t even bothered to seek medical help, thinking they simply have ``bad toes,″ doctors say.

In October, the Food and Drug Administration approved a new prescription treatment that can work in three or four months. It’s called itraconazole, which its maker, Johnson & Johnson, sells under the brand name Sporanox.

J&J is now touting its drug in a unique magazine and newspaper campaign that uses graphic photographs of diseased toes _ giving Americans an education they may not have wanted.

Although doctors praise the medicine, it’s anything but cheap. The typical treatment for what they call onychomycosis (ON-i-coh-my-CO-sis), can cost $1,000 or more. The treatment includes two pills a day for as long as it takes for the infection to disappear. But there’s no guarantee the infection won’t return.

``This medicine fills a niche because it will cure it quickly,″ said Dr. Paul Kechijian, a nail specialist at New York University Medical Center, who cautions: ``It’s not necessarily a long term cure.″

Funguses are microscopic plant organisms that can infect many parts of the body. Sporanox was first approved for sale three years ago, but only to treat internal fungus infections of the brain, esophagus or elsewhere.

Onychomycosis most frequently hits the big toe and other toes, but in a small number of cases can affect fingernails. The cause can be bad hygiene, but some people are simply genetically prone to it, Kechijian said.

Many people have accepted it. The worst that usually happens for a healthy man or woman is their nail falls off, said Robert Kniffin, a J&J spokesman.

J&J aims to change this complacent attitude with its striking ``Kick Toenail Fungus,″ ad campaign, now running in national magazines and newspapers.

The pictures aren’t pretty.

Those in consumer periodicals depict a life-sized fungus-infected big toe. Ads in medical journal are even more grisly _ a triple-sized nail at a much later stage of infection.

Why the gross-out?

``Many people are unsure what they have,″ said Scott Habig, a J&J marketing executive. ``By putting the picture there, I think we opened up a lot of doorways.″

Stephen Greyser, a professor of consumer marketing at Harvard University, agreed with the strategy, saying J&J must quickly create a market where none now exists and convince people it has their cure.

``They can’t sustain a big ad budget over the kind of time period that say, the heartburn category can. This has got to be a big hit, a big impact over a short term.″

Sporanox’s side effects, while less severe than its predecessors, are significant for a small number of people. In U.S. tests, liver damage occurred in about 3 percent of patients, said Kechijian. Digestive disorders and rashes affected 4 percent and 3 percent, respectively.

Also, the drug is unsafe for users of the hay fever drugs Seldane and Hismanol, Propulsid for gastric disorders and the sedative Halcion.

Sporanox costs up to 10 times the price of the older drugs. However, Dr. Richard Scher, nail disorder chief at Columbia-Presbyterian Medical Center in New York City, said the cost of a full cure treatment could be about the same because the older drugs work so much slower.

``There are additional lab tests and additional visits to doctors and the fact is the cure rate was low,″ said Scher.

There is some hope the price will come down in future years. At least two competitors are working on their own toe fungus cures.

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