Honestly I am not sure. My doctors, like yours, say the oral meds can pose too much of a strain on my kidneys. I have resorted to just getting gentle pedicures and I use lime when they fall off to clean it up and give some activity to heal. My doctors always say don't worry about it just let it fall off and come back. Sometimes they come back strong other times they just fizz out for a while. ~Racquel~ lupus team member