Laser Treatment of Toenail Fungus

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If you have toenail fungus—also known as onychomycosis, which can causes changes in the appearance and texture of the nail—laser treatment may be the answer. The FDA has approved a few different toptions for laser treatment.

Symptoms

The changes that occur to the toenail usually are gradual and tend to worsen over time. They can include:

  • Discoloration, usually yellow, white, or brown
  • Flaky debris under or on the nail
  • A detachment of the nail from the nail bed below (onycholysis)
  • Thickening of the nail or change in texture
  • Changes in the shape of the nail, such as an increase in curvature

Treatment

The gold standard for treating fungal nails has been prescription oral antifungal medications because they have been clinically more effective at clearing out the infection than topical antifungal treatments. But oral antifungal medications are often not an option for many people because of their side effects and potential interactions with other medications.

Given that toenail fungal infection is such a prevalent problem with no easy cure, newer laser treatment options have sparked a lot of interest and are now found in many podiatry offices.

Types of Laser Treatment

Different types of laser devices have been cleared by the FDA, such as the PinPointe Footlaser, GenesisPlus, and Noveon. Currently, laser devices are FDA-cleared for the "temporary increase in clear nails," which means that preliminary studies showed evidence of partial or total clearing of nail fungus symptoms—but the possibility exists that the infection could occur again. However, with any successful treatment of onychomycosis—whether it's oral medications, topical medications, or laser—there's always a risk that the infection could return.

So far there have been mixed results with laser treatment. While a 2018 study found it effective, particularly when combined with a topical antifungal, multiple reviews haven't found validity in laser treatments or have found issues with the quality of prior studies.

Since laser treatment of toenail fungus is a fairly new procedure, more studies are needed to get an idea of how it compares to other treatments.

How Does Laser Treat Onychomycosis?

Laser devices emit pulses of energy that impart heat to tissues that it contacts. The laser is theorized to exert antifungal activity when the mold or fungal cells absorb this heat, which kills the microbe. There may be other, still-unidentified factors at play which cause nail clearing.

The laser energy penetrates through the toenail, to the nail bed beneath where the fungus is likely also present. This ability to penetrate the full thickness of the toenail is probably what leads to the promising results seen thus far with laser treatment.

Each brand of laser differs in the method used for treating nails, but in general, the result is to utilize heat energy to eliminate the infection. Pulsing the laser or using specific wavelengths helps to minimize heating of the patient's skin, usually making the procedure pain-free. Patient information provided by some laser companies will state that a slight heating sensation will often be felt.

What to Expect With Laser Treatment of Onychomycosis

The initial consultation for laser onychomycosis treatment will involve an evaluation of the nail symptoms and possibly filing down of the nail (debridement). 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 patients have success with a single treatment, additional treatments may be prescribed depending on the results. Treatments will not clear a 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 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. Take the time to compare prices and treatment plans.

Traditional treatment of onychomycosis using oral or topical medications will likely be less than laser, especially because these services will have some or complete insurance coverage.

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Article Sources

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

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

  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. 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

  5. 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

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