Management of Toenail Fungus and Neck Skin Tags in a 43-Year-Old Male
Patient Presentation
A 43-year-old male presented to our dermatology clinic in Katy, Texas, with two main concerns:
Yellow, thickened toenails that had progressively worsened over the past 1–2 years.
Multiple skin tags on both sides of the neck that had become irritated by clothing and daily activities.
The patient was seeking evaluation, diagnosis, and treatment options for both conditions.
Clinical Examination
A comprehensive examination was performed, including inspection and palpation of the digits, toenails, and neck. The patient was alert, well-nourished, and in no acute distress. A dermatoscope was used for enhanced visualization.
Findings:
Toenails: Both great toenails showed yellow discoloration, thickening, and subungual debris, consistent with onychomycosis (fungal nail infection).
Neck: Several small, soft, pedunculated skin tags (acrochordons) were identified along the left and right anterior and lateral neck areas.
Diagnosis
Onychomycosis (B35.1) – fungal infection of the toenails, primarily affecting the right great toenail.
Acrochordons / Skin Tags (L91.8) – benign skin growths distributed bilaterally on the neck.
Treatment Plan
1. Onychomycosis
A nail clipping from the right great toenail was obtained and sent for PAS (Periodic Acid–Schiff) staining to confirm fungal involvement. Pending confirmation, the treatment plan includes initiating oral terbinafine—an effective systemic antifungal medication.
Because the patient reported a history of possible fatty liver disease, baseline liver function tests (LFTs) were ordered prior to starting therapy.
Patient Counseling:
Oral antifungal agents offer a higher cure rate than topical treatments, though recurrence is possible.
Possible side effects: liver toxicity, rash, and rare bone marrow suppression.
Instructions: Contact the office immediately if side effects such as nausea, fatigue, or jaundice develop.
Plan:
Await PAS results and lab confirmation.
Begin terbinafine therapy (typically 12-week course) upon clearance.
2. Skin Tag Removal
Given the patient’s cosmetic concern and mild irritation, in-office removal was performed during the visit.
Procedure Details:
Anesthesia: 3 cc of 1% lidocaine with epinephrine for local numbing.
Technique: Gentle gradle excision of five skin tags.
Locations: Left and right anterior and lateral neck.
Outcome: Minimal bleeding, no complications.
Post-procedure care:
Keep the area clean and dry for 24 hours.
Apply petroleum jelly or antibiotic ointment to prevent crusting.
Avoid friction from jewelry or collars.
Discussion
This case highlights two common dermatologic conditions—onychomycosis and skin tags—frequently seen in adult patients.
Onychomycosis is a fungal infection that affects both the appearance and integrity of the nail plate. Oral antifungal therapy, such as terbinafine, remains the most effective treatment option, especially in long-standing or severe cases.
Skin tags are benign and often removed for cosmetic reasons or due to irritation. In-office excision is a quick and effective treatment with minimal downtime.
At Village Dermatology in Katy and Houston, Texas, Dr. Reena Jogi and her team combine advanced diagnostic tools and safe procedural care to address both medical and cosmetic skin concerns.
Conclusion
The patient underwent successful skin tag removal and is pending laboratory confirmation for toenail fungus before starting oral antifungal therapy. With proper follow-up and adherence to the care plan, excellent outcomes are anticipated for both conditions.
