Laser Treatment for Toenail Fungus

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Laser treatment is one of the FDA-approved treatments for toenail fungus infection (onychomycosis), which causes changes in the appearance and texture of the nail. There are several types of laser treatments, including those that use light and carbon dioxide (CO2) lasers. While these treatments may cause pain and/or bleeding of the surrounding area, they are considered safe.

Because fungal infections can persist after laser treatment (or any treatment for onychomycosis, for that matter), repeated sessions are usually necessary to resolve a fungal infection. It may take between six and 18 months for laser therapy to be effective.

Symptoms and Causes

With onychomycosis, the visible changes of the toenail are usually gradual and tend to worsen over time.

Symptoms can include:

  • Yellow, white, or brown discoloration of the affected toenail
  • Flaky debris under or on the nail
  • Onycholysis: detachment of the nail from the nail bed below
  • Thickening of the nail or a change in texture
  • Changes in the shape of the nail, such as an increase in curvature

There are several types of fungus that can cause onychomycosis, and the condition may develop after trauma to the foot or as a complication of athlete's foot.

Effects of Laser Treatment

Several types of laser devices have been cleared by the food and drug administration (FDA), such as the PinPointe Footlaser, GenesisPlus, and Noveon. According to the FDA approved indications, these devices may produce a "temporary increase in clear nails in patients with onychomycosis."

In research studies, laser treatment partially or totally cleared nail fungus symptoms in over 50% of participants, but experts agree that the infection could occur again. Treatment is considered effective when the symptoms of the infection resolve and when there is no evidence of fungus on cultured samples of the toe or surrounding skin.

How It Works

Laser devices emit pulses of energy that impart heat to tissue such as nails and skin. The laser energy penetrates through the toenail to the nail bed where the fungus is likely also present.

The laser is believed to exert antifungal activity by killing the mold or fungal organisms. When these microbes absorb the heat, they are destroyed. Pulsing the laser or using selected wavelengths helps minimize heat on the skin, which reduces the risk of bleeding and pain.

There may also be other, still-unidentified factors at play which aid in clearing the infection.

What to Expect With Laser Treatment of Onychomycosis

An initial consultation for laser onychomycosis treatment involves an evaluation of the symptoms and possibly filing down of the nail (debridement). Typically, onychomycosis is diagnosed based on the appearance of the nail, but a sample may be taken for examination under a microscope if necessary.

The laser will be maneuvered over any affected nails, and may even be used over non-affected nails. One session typically lasts 30 minutes or less.

While some people experience resolution of the infection with a single treatment, additional treatments may be prescribed depending on the results. Even effective treatments are not expected to clear an infected nail immediately—it may take up 12 months until the nail grows out to determine if the treatment has been successful. The type of laser device used may also be a factor in the number of treatment sessions needed.

The cost of laser onychomycosis treatment is often a downside. The cost differs from one provider to the next but averages about $1,000, and some health insurance plans do not pay for this treatment. Because of the high cost, it may be worth your time to compare prices and treatment plans.

Traditional treatment of onychomycosis using oral or topical medications will likely be less costly than laser treatments, especially because the cost of these options is covered by most health insurance plans.

A Word From Verywell

The gold standard for treating toenail fungus has been prescription oral antifungal medications as they are more effective at clearing the infection than topical antifungal treatments. But oral antifungal medications can cause side effects and may interact with other medications.

Given that toenail fungal infection is a fairly prevalent problem with no easy cure, laser treatment options have sparked a lot of interest and have been increasing in availability.

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Article Sources
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  1. Bodman MA, Krishnamurthy K. Onychomycosis. StatPearls Publishing. 2019.

  2. U.S. Department of Health and Human Services. Medical devices and clinical trial design for the treatment or improvement in the appearance of fungally-infected nails. 2016.

  3. Weber G, Firouzi P, Baran A et al. Treatment of onychomycosis using a 1064-nm diode laser with or without topical antifungal therapy: a single-center, retrospective analysis in 56 patientsEur J Med Res. 2018;23(1). doi:10.1186/s40001-018-0340-y

  4. Hollmig ST, Rahman Z, Henderson MT, Rotatori RM, Gladstone H, Tang JY. Lack of efficacy with 1064-nm neodymium:yttrium-aluminum-garnet laser for the treatment of onychomycosis: a randomized, controlled trial. J Am Acad Dermatol. 2014;70(5):911-7. doi:10.1016/j.jaad.2013.12.024

  5. Westerberg D, Voyack M. Onychomycosis: current trends in diagnosis and treatmentAm Fam Physician. 2019;88(11):762-770.

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