OUR CLINICAL APPROACH
Smarter treatment. Not just more of it.
Pulse Therapy is an intermittent dosing protocol used by our physicians — delivering clinically comparable results to continuous daily regimens, with a more structured, manageable schedule and reduced cumulative exposure.
✔ Comparable outcomes to 12-week continuous regimens
✔ Strategically timed treatment cycles with rest periods
✔ Reduced cumulative medication exposure
✔ Prescribed and supervised by board-certified physicians
THE SCIENCE
What is Pulse Therapy — and why does it work?
Traditional antifungal treatment often follows a continuous daily dosing schedule for 12 or more weeks. While effective, this approach means prolonged, uninterrupted medication exposure — which can be harder to adhere to and accumulates over time in the body.
Pulse Therapy takes a different approach: treatment is administered in defined cycles — typically 7 days of active treatment followed by a scheduled rest period. This intermittent pattern produces outcomes comparable to continuous regimens for onychomycosis.
The principle: antifungal agents like terbinafine have a long half-life and remain active in nail tissue even during rest periods. The 'pulse' allows the medication to work between cycles — you're not losing ground during the off week.
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THE PROTOCOL
How a Pulse Therapy cycle works
Your physician designs your specific protocol. Here is a representative example:
Week 1 Active Treatment
Take your prescribed medication as directed — once or twice daily. This is your active dosing window.
Week 2–3 Rest Period
No medication taken. The antifungal remains active in nail tissue — continuing to work without new doses.
Week 4 Second Pulse
Second treatment pulse begins. Physician may adjust based on progress at follow-up.
Week 5–6 Rest Period
Second rest window. Medication continues working in nail tissue.
ONGOING Repeat & Monitor
Cycles continue as prescribed. Your physician monitors progress and adjusts the protocol if needed.
WHY PULSE THERAPY
Three reasons our physicians prefer this approach
By using treatment cycles rather than continuous daily dosing, Pulse Therapy limits total medication exposure — an important consideration for oral antifungals.
↳ Particularly relevant for oral terbinafine protocols
Reduced Cumulative Exposure
Published studies on pulse dosing of terbinafine demonstrate mycological cure rates comparable to continuous regimens — without requiring uninterrupted daily treatment.
↳ Backed by peer-reviewed clinical literature
Clinically Comparable Outcomes
Treatment cycles are easier to maintain than a daily-for-12-weeks commitment. A structured on/off schedule with clear milestones improves patient follow-through — and adherence is directly linked to outcomes.
↳ Consistency drives results
Better Adherence
WHY PULSE THERAPY
Three reasons our physicians prefer this approach
COMPARISON TABLE
Both approaches are clinically valid. Your physician determines which is most appropriate for your specific case.
CLINICAL BACKING
What the research says
Pulse dosing of oral terbinafine for onychomycosis has been studied in multiple clinical trials. A commonly referenced protocol involves one week of treatment per month for 3–4 months, with mycological cure rates reported in the range of 70–80% in various studies.
The rationale is pharmacokinetic: terbinafine has a long half-life and high affinity for keratinized tissue. After the active dosing week, therapeutic concentrations remain in the nail for weeks — the drug continues working during the rest period.
Our physicians apply this evidence base to design treatment plans that balance efficacy, tolerability, and patient adherence — with ongoing monitoring to adjust as needed.
Pharmacokinetic curve — terbinafine concentration in nail tissue across pulse cycles
IS IT RIGHT FOR YOU?
Who may benefit from Pulse Therapy
✔ MAY BE APPROPRIATE FOR:
✔ Patients with moderate to severe onychomycosis
✔ Patients prescribed oral terbinafine
✔ Those who prefer a structured cycle vs. daily routine
✔ Patients where reduced exposure is a clinical consideration
✔ Cases requiring long-term treatment management
✘ MAY NOT BE APPROPRIATE FOR:
➝ Patients with contraindications to oral terbinafine
➝ Those who prefer or require a continuous daily regimen
➝ Mild cases manageable with topical treatment alone
➝ Patients who cannot commit to follow-up monitoring
➝ Cases where immediate aggressive treatment is indicated
Only a physician evaluation can determine which protocol is right for your case. The evaluation is free.
While Pulse Therapy is our primary clinical approach, our physicians may recommend continuous therapy as an alternative depending on the individual clinical presentation.
CLINICAL AUTHORITY
Developed and applied by board-certified podiatric physicians.
Dr. Abraham Wagner, DPM — Double Board-Certified Podiatric Surgeon, Hollywood, Florida.
Every Pulse Therapy plan is designed and supervised by a licensed, board-certified physician.
Protocol grounded in peer-reviewed clinical literature on intermittent antifungal dosing.
Your physician reviews your progress throughout treatment and adjusts the plan as needed.
GET STARTED
Want to know if Pulse Therapy is right for your case?
Complete your intake form. A board-certified physician will review your case and determine whether Pulse Therapy — or another protocol — is most appropriate for you.