Laser Treatment for Toenail Fungus

Table of Contents
View All

Laser therapy is a treatment for toenail fungus infection (onychomycosis), a hard-to-treat infection that changes the appearance and texture of the nail. There are several types of laser treatment options, including those that use light and those that use carbon dioxide (CO2). Laser therapy is approved by the U.S. Food and Drug Administration (FDA) for this use.

Close-up of feet at the beach
4FR / E+ / Getty Images

Fungal infections of the nails usually require several laser treatment sessions before they completely resolve. It may take between six and 18 months of consistent treatments for laser therapy to be effective. While these treatments may cause side effects such as pain and/or bleeding of the surrounding area, they are considered safe.

How It Works

Laser devices emit pulses of energy that produce heat. When used to treat onychomycosis, the laser is directed so the heat will penetrate through the toenail to the nail bed where the fungus is present.

For this type of treatment, CO2 lasers or yttrium-aluminum-garnet (YAG) lasers with wavelengths of 870 nm, 930 nm, or 1320 nm are used to increase the localized temperature. In response to the heat, the infected tissue is gasified and decomposed, destroying the fungus and the surrounding skin and nail. The heat from the lasers also has a sterilizing effect, which helps prevent new fungal growth. 

When the laser is targeted to the area of infection, the heat that's produced inhibits the growth of the fungus and destroys it.

When used safely, laser treatment doesn't emit enough energy to destroy all the tissue—or all of the infection. For that reason, repeat treatment is typically needed. The fungal growth is inhibited and some of the fungal microorganisms are destroyed, but since the infection can partially survive the treatment, it's unlikely that you will be completely cured with just one session.

Efficacy

Several types of laser devices have been cleared by the FDA for the treatment of onychomycosis, including PinPointe Footlaser, GenesisPlus, and Noveon. According to the criteria for approval, these devices may produce a "temporary increase in clear nails in patients with onychomycosis."

With laser therapy, most people experience noticeable improvement, and there is a high cure rate as well. One study showed a 61% cure rate at 16 weeks. Another study showed 91% clinical improvement and a 30% cure rate at 180 days.

Laser treatment is associated with high rates of negative cultures—which means that a laboratory microscopic test for a fungal infection typically doesn't show evidence of infection after treatment.

Treatment of onychomycosis is considered effective when the symptoms of the infection resolve and there is no evidence of fungus on cultured samples of the toe or surrounding skin.

Laser Treatment Compared to Other Options

Laser treatments are typically more effective than other ways of treating onychomycosis. This infection can be treated with topical (on the skin) antifungal medications or oral antifungals, and there are over-the-counter, as well as prescription options. Oral antifungals cause systemic side effects and are not totally effective for curing onychomycosis. Topical treatments tend to be safe, but are not very effective.

Research shows there's an approximately 45% improvement of onychomycosis with topical medicine and approximately 40% to 66% improvement with oral medication.

However, there does seem to be a range in the efficacy with all of these treatments. Using them consistently while avoiding side effects can be tedious. And combining treatments may be more effective than using a single treatment approach.

What to Expect

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

Your treatment will be administered by a doctor, who may be a dermatologist, family doctor, or podiatrist. You might also have a debridement, in which your toenails are clipped and dead skin is cleaned, on the day of your laser procedure or a few days beforehand.

Right before your procedure, your foot will be cleaned with a sterile solution and placed in an accessible position to direct the laser. The laser will be maneuvered over any affected nails, and may even be used over non-affected nails if there is a concern that you could have involvement of the fungal infection there too.

Pulsing the laser or using selected wavelengths helps minimize heat on the skin, which reduces the risk of side effects. One session typically lasts 30 minutes or less.

As the tissue decomposes, pain and/or bleeding can occur, but the skin will heal in a few days. Your doctor will explain how you should keep your toe clean and dry as it is healing.

Signs of Improvement

While some people experience resolution of the infection with a single treatment, additional sessions 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 before you can tell whether the treatment has been successful.

Signs of improvement include:

  • The disappearance of yellow, white, or brown discoloration of the affected toenail or toenails
  • Resolution of flaky debris under or on the nail
  • Recovery of onycholysis, which is detachment of the nail from the nail bed below
  • Normal shape and texture of new nail growth with no more thickness, bumps, or altered nail shape

A Word From Verywell

When you're considering treatment options for toenail fungus infection, there are a number of factors to keep in mind. Oral medications can cause side effects, and topical medications require consistent treatment, often with little improvement to show for it.

While laser treatments might be more effective, the time commitment of making multiple appointments for repeat laser treatments could be a burden. Expense could be a factor too because some health insurance plans don't cover the whole cost for this treatment. As you discuss your options with your doctor, you will need to think about the pros and cons of each of your choices.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Zalacain A, Merlos A, Planell E, Cantadori EG, Vinuesa T, Viñas M. Clinical laser treatment of toenail onychomycoses. Lasers Med Sci. 2018;33(4):927-933.doi:10.1007/s10103-017-2198-6

  2. Ma W, Si C, Kasyanju carrero LM, et al. Laser treatment for onychomycosis: A systematic review and meta-analysis. Medicine (Baltimore). 2019;98(48):e17948.doi:10.1097/MD.0000000000017948

  3. 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.

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

  5. Bodman MA, Krishnamurthy K. Onychomycosis. StatPearls Publishing. 2019.

  6. 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

  7. 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