Laser treatment for fungal toe nails
WHAT IS ONYCHOMYCOSIS
Onychomycosis is a fungal infection of the toenails. Dermatophytes are the fungi most commonly responsible for onychomycosis. It is a very common condition and is estimated to impact 26% of the population with older people in 80% of cases. You may suffer from onychomycosis if you have one or more of the following symptoms:
- Thickening nail
- Crumbly or brittle nail
- Nail distorted in shape or separated
- Nail with no luster or shine
- A white, yellow, orange or brown coloured nail
- Debris build-up under the nail
- Persistent athletes foot or tinea pedis
Fungal nail infections of the toes and finger nails are difficult to treat because fungus is persistent and can get deep within the hard nail or deep under the nail bed. Topical treatments such as Curanail are licensed for mild infection affecting up to two nails but are unable to penetrate well under the nail. More extensive infections require a stronger approach requiring tablets such as terbinafine (Lamisil) or Sporanox (itraconazole) which are used with some success. Cure rates
with tablets are between 60-80% but there are concerns about side effects due to a 3-6 month treatment time.
A&A Podiatrists have been at the forefront of laser treatments directed at the fungus within the nail since 2009. Lasers, widely used for many areas in medicine can target the fungal cells specifically causing them to over heat or produce reactive oxygen – both causing it to begin killing the fungus. Our approach is tailored to the individual and can take several months as the nail grows out slowly. Your initial consultation will discuss the ‘plan of attack’!
Laser therapy uses light at particular wavelengths to interact with fungus without affecting the healthy skin or body being targeted to specific features of the nail and fungus.
A&A Podiatrists use two different lasers to achieve optimum results for this persistent infection: The Lunula and The PinPointe FootLaser.
In the former, two beams of light (blue and red) are produced by the Lunula laser which are rotated over the foot and nails that cause the fungal cells to react and produce hydrogen peroxide within their cells. This in most cases is cumulative over a few weeks when repeated and reduces the amount of viable fungus within and below the nail.
The second laser – the PinPointe FootLaser uses a targeted YAG laser to heat the fungus within and around the nail. This heats the fungal cells rapidly causing fungal damage. This laser produces some heat within the nail but it is stopped once it becomes uncomfortable.
This begins with an assessment of the foot and nails and takes a holistic approach. Identifying causative factors, sources of fungus as well as considering the duration of infection and damage to the nails caused by the fungus, trauma or footwear. Overall general health and hygiene factors are discussed and methods of reducing cross infection or reinfection.
A&A Podiatrists take a thorough and long term approach to treatment with laser. Our treatment plan lasts six months to ensure we monitor the progress of the nail growth and continue treatment until the nail is well on its way to becoming clear.
There are two lasers used. The first is the Lunula laser which takes 12 minutes per foot. The second is the PinPointe FootLaser. These are used in combination as needed. In some cases (where the nail is very thick and fibrous) we have removed the nail surgically to remove all the infected nail before using the laser and allowing the nail to grow back.
As above, treatment commences with a consultation and discussion of causative and preventative methods. Anti-fungal cream is prescribed and baseline photographs taken. The thickened and fungal areas of the nail are thinned with a water file to remove as much loose fungus and nail as possible. A typical regime consists of two phases. An initial 3 month treatment phase whereby we aim to use the Lunula laser 1-2 times a week for much of this time (minimum 4 sessions, aim for 10+) and the PinPointe FootLaser between 2 and 4 times, also weekly (depending on severity) This is followed by a monitoring period for 3 more months where the Lunula is used every 2-4 weeks as the nail grows.
The cost of treatment is typically broken down into a per foot charge. This fee will cover treatment for the entire 6 months. Potentially this could be 10 Lunula sessions and 4 PinPoint treatments in the first 3 months, followed by 6 Lunula and 3 PinPointe treatments in the second three month period. There would also be a review every 6 weeks and photographs to monitor.
The per-foot cost is on average £300 for a six month plan – so £600 for both feet. If the nails are to be removed this is an additional £100-£600 depending on the number of nails.
Payment is due in full at the start of treatment. For both feet treatment, this is usually broken into two payments of £300 at the start and at 2 months.
The effectiveness of all treatments varies. Research shows up to 88% effectiveness though we would expect 50-78% to be more reflective overall. The degree of infection, nail damage and duration of infection can cause variable results and would be discussed on a case by case basis when this is the case.
In some persistent cases or when it is one severely infected nail, the nail can be removed and treated as the new one grows back. In other cases oral terbinafine would be advised through your GP.
It is also possible to cover the nail with a specific acrylester gel for the toes that can be moulded and bonded over the ‘stump’ of fungal nail. This is called a Pedique and more information can be located on this link. This, once covered with nail will look normal and will do so until it grows out over time (typically 3-6 months). It is not appropriate to do this within the treatment phase of laser therapy but can be used after whilst it is growing out. For some this is a cosmetic alternative to laser treatment or where the nail is damaged and there is no fungus.