Doctor Sussamn's Blog
Wednesday, September 12, 2018
Published: April, 2010
Q. I've tried a lot of things for a fungal infection in one of my toenails, but it just won't go away. What do you know about a new treatment that uses laser?
A. Two lasers using different types of laser energy have attracted attention as treatments for fungal infection of the toenails, a condition called onychomycosis (pronounced oh-nee-koh-my-KOH-sis), which can also affect the fingernails: Noveon and the PathoLase PinPointe FootLaser. The theory is that a precisely directed laser can eliminate the fungus without harming the surrounding nail tissue. The underlying technologies are already in use for other conditions, including cataract surgery, dental work, and hair removal. Although there is some laboratory evidence that lasers can squelch fungal organisms, clinical studies in humans thus far are limited.
In 2008, the company that makes Noveon (Nomir Medical Technologies) announced the results of a study involving 39 toenails. After four treatments, about half of the toenails no longer had active fungal infection and 76% showed improvement. The findings are difficult to evaluate, because they were presented at a scientific meeting and published in the meeting abstracts but have not yet been published in a peer-reviewed journal. There is no study comparing laser to other widely used treatments, and its long-term effects are unknown. As we go to press, neither of the lasers has received FDA approval for the treatment of toenail fungus.
The desire to find a cure for onychomycosis is understandable. Fungal infection can cause a toenail to thicken and look crumbly, discolored, and distorted. The nail can become difficult to cut and a source of embarrassment. Worse, it may be painful and make walking difficult. In people with diabetes or a suppressed immune system, toenail fungus may progress to more serious infections.
Fungi thrive in moist environments, so it's important to keep your toenails short and as clean and dry as possible. Here are some tips:
Dry your feet and toes thoroughly after showering or bathing. If you have a hair dryer, use it on a low setting to dry your toes.
Always wear shoes in locker rooms, in public showers, and around public pools.
Whenever possible, wear synthetic socks that wick moisture from your feet; if your feet sweat a lot, change your socks during the day.
Wear shoes that fit well and are made of breathable materials.
Avoid tight-fitting socks and stockings, which can trap moisture between your toes.
Don't pick the skin around your toenails.
Use antifungal spray or powder in your shoes or on your feet.
Keep your pedicure instruments clean and disinfected, and if you use a pedicure salon, make sure your pedicurist does the same.
Don't try to cover up the infected toenail with nail polish. It will trap moisture and worsen the infection.
The fungus is notoriously difficult to eradicate. Fungi are very hardy microorganisms. They can invade the nail through a tiny crack in the skin or even a small separation between the nail plate and nail bed. There are many over-the-counter nail creams and ointments, but none of them is very effective. Topical ciclopirox (Penlac) works somewhat better than a placebo, but it's not a cure. So far, prescription oral antifungal medications have the best track record, though they're not an easy fix. They must be taken for at least six to 12 weeks, and they can have side effects such as a rash, diarrhea, and liver damage, so users must be monitored by a clinician. If treatment succeeds, a new fungus-free nail will grow out to replace the old one, a process that may take several months. Even after successful treatment, the fungal infection may return in as short a time as a year.
The interest in laser treatment is growing partly because it does not have the side effects of oral medication. Despite the lack of FDA approval, some podiatrists are already using the PathoLase PinPointe laser. It's painless and takes only 10 minutes per toe. But the cost (roughly $1,000) is not covered by any health insurance, and, more important, there is little information about its long-term safety and effectiveness. For the time being, I suggest that you save your money and explore currently approved therapies under the care of an experienced clinician.
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Tags: Laser treatment for toenail fungus
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