Back in April, in our Blog entitled: “Achoo! The Common Cold of the Feet” we discussed in detail, fungal nail infections. Much discussion, in both the Podiatric and Dermatologic communities surrounding Laser Therapy Treatment for onychomycosis (fungal nail infections), has surfaced in recent months and years. The topic of laser therapy was briefly mentioned in April’s blog, but this week, I’d like to provide you with a little more insight as to what Laser Therapy aims to do in order to treat fungal nail infections, and if it will be effective or not.
Lets quickly review the basics: what is onychomycosis? Onychomycosis (on-EE-ko-my-KO-sis) is a fungal infection of the nail that can be caused by 3 types of fungus: non-dermatophytic molds, yeasts, and dermatophytes. The most common infective "bug," accounting for 70% of all toenail infections, is a dermatophyte by the name of T. rubrum. The names, none of which are important, mean very little in relation to treatment modalities that can be used. It is, however, important to know that the types of fungus causing toenail infection thrive in moist environments, therefore keeping feet clean and dry helps prevent infection by one of these "bugs." It is also important to clean community showers frequently with chemicals like bleach, killing any organisms living on the tile. Wearing shower shoes, in situations where you are not responsible for cleaning, is also a wise decision!
When the organism gets into the bed of the nail and/or the nail matrix (the tissue from which the nail grows), your nails will become thickened, discolored, and often brittle. Patients experience associated pain with fungal nails due to increased thickness which causes the nails to become pressed up against the inside of shoes. Nails become difficult to trim at home and embarrassment in open-toed shoes or sandals is imminent!
Treatments, as they are currently available, do very little for long-term cures. Several pills and nail lacquers do help the appearance of nails and decrease thickness. However, they are not without their side-effects, and when use of these medications are discontinued reoccurrence of fungal infection is likely is 70% of patients. Over the counter methods such as mouthwash, Vicks Vapor Rub and Vitamin E lotion seem to benefit in decreasing thickness, but long-term research studies have yet to be conducted to determine the effectiveness of such remedies for providing a cure. My guess would be that their cure rates would be similar to oral and topical prescription medications, as fungal nail infections are typically VERY difficult to treat. The problem with treating and curing fungal infections long-term is seeded in the way the fungus manifest within the nail, making it very difficult to get to the source of the infection and kill it from the inside out.
The science behind laser therapy for treatment of onychomycosis is still relatively new, unknown and lacking research! The Patholase "Pinpoint Foot Laser" featured in the news recently, although approved by the FDA for use in Dentistry and Soft-Tissue cutting, is not currently FDA approved for the treatment of Onychomycosis. The initial study Patholase conducted to support its "off-label" use for the treatment of toe-nail fungus centered around 16 patients, which is never large enough of a research pool to deem something effective and safe for continued use. The price is astronomical, mentioned to be close to $1200 per session to have all 10 nails treated, with no safe bets for complete resolution of fungal infection.
The Noveon Laser, by Nomir Medical, is a laser therapy device currently undergoing FDA Clinical Trials for approval of its use in treating Onychomycosis. It holds more promising evidence than Patholase in its effectiveness in treating and possibly curing fungal nail infections. At this time, Nomir Medical makes no claims that treatment with its laser is more or less effective than the currently available oral and topical medications and admits that further clinical trials need to be conducted.
In short, fungal nail infections are extremely difficult to treat and only time and continued research will tell if a long-term cure is a possibility, especially in the realm of Laser Therapy. The best option available today is to try one of the currently approved methods, and once treatment has concluded, prevention of reoccurrence becomes key!
For more on prevention of recurrence, check back to Aprils blog!
