Laser Treatment for Toenail Fungus

By:    Medically Reviewed: Tom Iarocci, MD   Published: April 30, 2014

Laser treatment for toenail fungus may be an option for some people.

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If you have ever tried to hide your feet because of embarrassing looking toenails due to toenail fungus, you are not alone. Toenail fungus affects about 15 percent of adults between the ages of 40 and 60, according to the American Podiatric Medical Association.

Currently, the main treatment for toenail fungus is medication, either topical or oral. Although oral medications may be effective for some people, not everyone is a good candidate for oral therapy, and laser treatment for toenail fungus is now an additional option.

 

What is Laser Treatment?

 

Lasers have been used clinically for years to treat various conditions including polyps, kidney stones and tumors. Medical lasers use a precisely focused high intensity light to destroy or shrink tissue.

 

When it comes to treating toenail fungus, the U.S. Food and Drug Administration (FDA) approved a few laser systems that work slightly differently.

 

“There are different lasers on the market to treat toenail fungus,” says Michael Uro, DMP, a podiatrist in private practice in Sacramento, California. “For example, the 1064 YAG laser uses a specific wavelength and kills the fungus using selective photothermolysis. This means that the organisms are heated up to a point where they are effectively killed,”

 

A second FDA-approved laser called the Noveon NaiLaser differs from the 1064 YAG in that it uses two wavelengths as opposed to one. It also uses cooler temperatures than the 1064 YAG, which some patients may prefer. Both laser systems target the fungus, and healthy tissue around the nail is not harmed. The number of treatments needed to clear the nail will vary.

 

Laser technology continues to evolve. In Europe, the Lunula Laser has been given the CE mark, which is the equivalent of FDA approval in the U.S. “Lunula Laser works by stimulating the body’s immune system to fight off the fungus, as well as kill the fungus by creating hydrogen peroxide to break down the fungi,” said Uro. As of the original publish date of this article, the Lunula Laser has not yet been cleared by the FDA.

 

Regardless of which laser system is used, most people who have toenail fungus are a candidate for the treatment, but there can be exceptions. “People with extremely poor circulation and those with a compromised immune system may be advised not to have the procedure,” says Uro.

 

Is it Effective?

 

The jury is still out on how effective laser treatment is for toenail fungus, partly because there has not been a large number of studies completed.

 

“Studies have shown a wide variation in results with nail clearing in anywhere from 50 to 90 percent of patients involved. Early data are promising, but studies are limited in number and quality,” says Jeffrey DeSantis, DMP, board member of American Podiatric Medical Association Board of Trustees and president of Cambridge Foot & Ankle Association. “Larger randomized, controlled and blinded studies are needed with a more definitive evaluation of what constitutes a ‘cure’ before a conclusive determination of effectiveness can be made.”

 

A cure may take some time, regardless of the treatment used, and laser treatment along with treatment of a patient’s foot fungus using a topical agent may be indicated.

 

Other Toenail Fungus Treatment Options

 

If laser treatment is not something you want to try or it has not been effective, you do have other treatment options. For instance, medication is available that can be applied to the toenails. The effectiveness of topical medications may vary since they are often unable to penetrate the entire nail and destroy the fungus.

 

In addition to topical medication, oral medication is also an option to treat toenail fungus. Oral antifungal medications work by destroying the fungus causing the infection. But unlike topical medications, they are systemic, which means they have an effect on the whole body, not just the nails. Side effects are usually uncommon but can include liver and kidney damage.

 

Although it may be a last resort, debridement (i.e., removal of damaged tissue from a wound) or surgery for toenail fungus may be suggested. In cases where the infection is severe and causing pain, surgery to remove the infected nail may be performed.

 

Next Steps

 

  • Recognize early signs of toenail fungus. Toenail fungus has early warning signs, such as a white or yellow spot under the nails. When treated in its early stages, it is easier to cure. Treating it early may also prevent the fungus from spreading to other nails.  
  • Check with your insurance company. If you are considering laser treatment for toenail fungus, check with your health insurance provider prior to treatment to see if the procedure is covered. Some insurance companies may consider laser treatment for toenail fungus cosmetic and will not cover the cost.
  • Find a podiatrist who does laser surgery. Although many podiatrists use lasers in their practice to treat conditions, such as ingrown nails or warts, they may not perform laser treatment for toenail fungus.
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sources
  • Desantis J., DMP, board member of American Podiatric Medical Association Board of Trustees and president of Cambridge Foot & Ankle Association. http://www.cambridgefoot-ankle.com/Our_Doctors.php. Interviewed April 2014.
  • Uro M., DMP, private practice podiatrist of Dr. Michael URO Foot Care in Sacramento, Calif. http://toelaser.com/index.php/about-dr-uro/dr-uro. Interviewed April 2014.
  • American Podiatric Medical Association. “Toenail Fungus.” http://www.apma.org/Learn/FootHealth.cfm?ItemNumber=1523. Accessed April 2014.
  • NYU Langone Medical Center. “Onychomycosis.” Updated December 2013. http://medicine.med.nyu.edu/conditions-we-treat/conditions/onychomycosis. Accessed April 2014.
  • U.S. Food and Drug Administration. “Medical Lasers.” Updated March 2014. http://www.fda.gov/radiation-emittingproducts/radiationemittingproductsandprocedures/surgicalandtherapeutic/ucm115910.htm. Accessed April 2014.
  • Gupta A., Simpson F. “Newly Approved Laser Systems of Onychomycosis.” Journal of American Podiatric Association. 2012; 102 (5); pages 427-430. http://www.ncbi.nlm.nih.gov/pubmed/23001739. Accessed April 2014.
  • Nomir Medical. “Nomir Medical Announces FDA Clearance for Noveon NaiLaser.” March 2014. http://www.noveonlaser.com/sites/default/files/Noveon-NaiLaser-FDA-Clearance-Press%20Release_3-12-14_0.pdf. Accessed April 2014.
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