Laser Treatment for Toenail Fungus

Laser therapy is a treatment for toenail fungus infection (onychomycosis). Fungal infections of the nails usually require several laser treatment sessions before they get better. It may take six to 18 months of consistent treatment for laser therapy to be effective for toenail fungus.

Laser treatments for toenail fungus are considered safe but can cause side effects such as pain and/or bleeding of the area around the nail. Laser therapy is approved by the U.S. Food and Drug Administration (FDA) to treat toenail fungus.

This article will go over what you should know about using laser treatments for toenail fungus.

How Laser Therapy Treats Toenail Fungus

There are several types of laser treatments that can be used to treat toenail fungus, including some that use light and others that use carbon dioxide (CO2).

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

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.

In response to the heat, the infected tissue turns into a gas and breaks down, destroying the fungus as well as the surrounding skin and nails. The heat from the lasers also has a sterilizing effect, which helps prevent new fungal growth.

When used safely, laser treatment does not emit enough energy to destroy all the tissue or all of the infection. Therefore, repeat treatment is usually 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 of toenail fungus with just one session of laser therapy.

How Well Does Laser Therapy Work for Toenail Fungus?

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

With laser therapy, most people see noticeable improvement and there is a high cure rate. 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.—that means a laboratory test for a fungal infection does not show evidence of infection after treatment.

How Does Laser Therapy Compare to Other Treatments?

Laser treatments are typically more effective than other treatments for nail fungus.

A nail fungus infection can sometimes be treated with topical (on the skin) antifungal medications or oral antifungals. There are also over-the-counter (OTC) and prescription options. Antifungals taken by mouth (oral) can cause full-body (systemic) side effects and do not necessarily cure toenail fungus. Topical treatments are generally considered safe but may not be effective.

Research has shown there is approximately 45% improvement in toenail fungus with topical medicine and approximately 40% to 66% improvement with oral medication.

However, there seems to be a range in terms of how well these different treatments work. Using them consistently while avoiding side effects can be difficult. Combining treatments might be more effective than using a single treatment.

What to Expect

At your first consultation for laser treatment of nail fungus, your provider will ask you about your symptoms. Typically, onychomycosis is diagnosed based on how the nail looks but they might want to take a sample to look at under a microscope.

Your treatment will be administered by a healthcare provider such as a dermatologist, family physician, or podiatrist. You might also have a procedure to have your toenails clipped and dead skin cleaned (debridement) on the day of your laser treatment or a few days before.

Right before your procedure, your foot will be cleaned with a sterile solution and put in an accessible position so the provider can direct the laser. The laser will be moved over any affected nails, and might also be used over non-affected nails if there is a concern fungus could be growing there.

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

Signs of Improvement

While some people experience resolution of the infection with a single treatment, additional sessions might be prescribed depending on the results.

Even effective treatments are not expected to clear an infected nail immediately—it may take up to 12 months until the nail grows out and you'll be able to tell whether the treatment has been successful.

Signs of improvement in toenail fungus after laser therapy 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 nail detachment from the nail bed below (onycholysis)
• Normal shape and texture of new nail growth with no more thickness, bumps, or altered nail shape

Summary

There are several types of laser therapy that can treat toenail fungus. You may need to have several sessions and wait for your nails to grow (which can take up to 12 months) before you'll see improvement. There are also some other treatments you can try for toenail fungus, like OTC and prescription topical and oral medications.

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 healthcare provider, you will need to think about the pros and cons of each of your choices.