Toenail Fungus Treatments

Toenail Fungus Laser Treatment - A Comprehensive Guide

Scientists and physicians are finding new ways to apply lasers to the treatment of human disease. Perhaps the most widely known application of lasers in medical and surgical care has been in the arena of laser eye surgery. Lasers are used to reshape the cornea of the eye in order to correct refractive errors and cure nearsightedness or farsightedness. However laser treatments have been used in various fields from dermatology to dentistry.

A laser, which is a concentrated beam of light energy, has the ability to selectively destroy certain biological structures, vaporizing them in very real terms. Depending of the wavelength of the light used in the laser, the type of biological structure being destroyed can be selectively targeted (more or less) and preferentially destroyed.

The use of lasers to treat nail fungus is not new. Researchers have been trying to use lasers to treat onychomycosis since the 1980s. The approach at that time, however, was a little different. Before newer antifungal treatments like Lamisil and Sporanox, the only oral medical treatments that existed for onychomycosis were griseofulvin and, a little later, ketoconazole. These drugs took a very long time to work, had potentially severe side effects at even modest doses, and often did not even work at all. The original application of lasers in the treatment of nail fungus was to use the laser to create holes or channels in the nail. This process, called fenestration, was meant to give topical onychomycosis treatments better access to the fungus. The laser could open up a pathway so that the medicine applied to the nail could get at the fungus and kill it.

This approach did not meet with much success. The process was expensive and did not seem to improve the topical treatment of onychomycosis to any great degree. As lasers were evolving and more widely available to physicians and surgeons, a better approach was adopted. By using a laser with a specific wavelength of laser light energy, the fungus could be targeted and killed, while leaving the skin and nail intact. Instead of making large tunnels in the nail, the light was focused on the fungus directly. In essence, the laser energy heats the fungus to the point that it is killed but does not burn the surrounding tissue.
It is this latter approach that is gaining ground among dermatologists is the United States. While the FDA has not approved any laser systems specifically for the treatment of nail fungus or onychomycosis, similar devices have been cleared by the FDA for use in other diseases and medical fields. Some companies are waiting on FDA clearance for this application but at least one company has not. Outside of a clinical study, patients having nail fungus laser treatment will be getting that treatment from this device manufacturer that released the technology before FDA clearance.
It is not yet clear whether nail fungus laser treatment actually works.

There have only been a couple of small clinical trials that have looked at the efficacy of laser onychomycosis treatment. As with many small, early trials of a new technology or application, the results have been favorable. However, as medical science has witnessed many times before, when these same technologies that perform well in small studies were tried in larger groups of people with more rigorous test protocols, many of them fail to show the same degree of benefit. At this point it is too early to say if nail fungus laser treatment is worth the price.
The Treatment can be expensive. Nail fungus laser treatment costs between $1,000 and $2,500. The laser onychomycosis treatment is not covered by health insurance since onychomycosis is viewed as a cosmetic disease (which is more or less correct, barring complications or severe disease). Therefore the cost of laser nail fungus treatment must be covered in full by the patient.
The procedure is very safe with remarkably few side effects. Therefore the risk to the patient is basically just money. Are you willing to risk a thousand dollars on a new, unproven application of laser technology? Some people are willing since nail fungus laser treatment promises to shorten the course of treatment by weeks over oral medicines. When faced with an unappealing and potentially disfiguring disease, patients are willing to spend reasonably large sums of money for a rapid solution to the problem.
It may be possible to find a clinical trial of laser onychomycosis treatment in your area. These studies are usually conducted at or near a large academic hospital, but may be conducted at an office near you. The website www.clinicaltrials.gov provides a listing of all of the clinical trials registered in the US and in several other countries. While you risk having a placebo (fake) treatment if you enroll in one of these clinical trials, you may also save yourself $1,000 or more.

Reference
Bornstein E. A Review of Current Research in Light-Based Technologies for Treatment of Podiatric Infectious Disease States. J Am Podiatr Med Assoc 2009;99:348-352.

This entry is filed under Treatment Reviews. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.