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2440 Whitney Avenue
Hamden, CT 06518

Telephone: (203)281-5737

Nail Fungus

Nail Fungus -- Onychomycosis -- Laser Treatment

Nail Fungus

Onychomycosis -- Laser Treatment

The newest application for our Cool Glide Genesis Nd:YAG laser is the ablation of a fungus infection within a nail. Utilizing the very specific wavelength of 1064nm, this laser is able to cause photo damage and/or ablation of the fungus within the nail.

Onychomycosis (OM) is a fungal infection that affects the toenails or the fingernails. OM, while not life threatening, can be painful and can produce disfigurement as well as physical and occupational limitations. The effects of OM are widespread, including psychosocial and emotional issues which may have a significant quality of life impact.

How OM occurs depends on the subtype. In the most common form of OM, the fungus spreads from skin of the bottom of the foot and invades the nail bed. Inflammation occurring in these areas of the nail causes the typical physical signs of OM. OM can present as total involvement of the entire nail unit (see the image below).

 Laser Treatment

The use of the Nd:YAG laser is the latest technology we have to help with onychomycosis. The laser energy penetrates the nail painlessly to kill the fungus in the nail bed.

Laser treatment for onychomycosis (OM) is a revolutionary breakthrough in treating nail fungus infection. Laser fungus nail treatment does not use cuts or burns and is therefore not uncomfortable.

So far no known side effects have been found in the studies on laser treatment for OM. Short term results have been been extremely encouraging and long-term effects seem just as promising. Coupled with good hygiene of the toes, and follow up treatment with a topical anti-fungal cream, patients should experience good, long-term results in the elimination of the nail fungus.

 International

Various reports differ on how common OM is in North America, ranging from 2% to 13%. OM accounts for half of all nail disorders, and it is the most common nail disease in adults. Toenails are much more likely to be infected than fingernails.

 Race

Onychomycosis affects persons of all races.

 Gender

Onychomycosis affects males more commonly than females.

 Age

According to studies adults are 30 times more likely to have OM than children. OM has been reported in 2.6% of children younger than 18 years but as many as 90% of elderly people.

 History

Onychomycosis is usually asymptomatic; therefore, patients usually first complain for cosmetic reasons without any physical complaints.

  • With advancing disease, there may be problems with standing, walking, and exercising.
  • There may be numbness, pain, discomfort, and loss of dexterity. Patients also may report loss of self-esteem and lack of social interaction.
  • A careful history may reveal many environmental and occupational risk factors.

 Physical

There are different subtypes of OM with differing appearances:

  • All images courtesy of Dr Antonella Tosti.

 Causes

There are 3 main classes of fungi that cause OM: dermatophytes, yeasts, and nondermatophyte molds. Dermatophytes are by far the most common cause of onychomycosis. Two major pathogens are responsible for approximately 90% of all onychomycosis cases. Trichophyton rubrum accounts for 70% and Trichophyton mentagrophytes accounts for 20% of all cases.
Risk factors for OM include family history, advancing age, poor health, prior trauma, warm climate, participation in fitness activities, immunosuppression (eg, HIV, drug induced), communal bathing, and occlusive footwear.

 Medical Care

Treatment of onychomycosis depends on the clinical type of the OM, the number of affected nails, and the severity of nail involvement. Systemic treatment is required in some types. A combination of systemic and topical treatment increases the cure rate but the rate of recurrence remains high, even with newer agents, and so the decision to treat should be made with a clear understanding of the cost and risks involved, as well as the risk of recurrence. Laser treatment now represents state-of-the-art.

 Topical Antifungals

Topical treatments alone are generally unable to cure onychomycosis because of insufficient nail plate penetration. They may be useful as adjunctive therapy and as prophylaxis to prevent recurrence in patients cured with laser treatment.

 Oral Therapy

Oral therapy has been limited in its effectiveness by long treatment programs, low cure rates and high reported adverse effects. To decrease the adverse effects and duration of oral therapy, topical treatments and laser treatment may be combined with oral antifungal management.

 Surgical Care

Surgical approaches to onychomycosis treatment include mechanical, chemical, or surgical nail removal.

  • Chemical removal by using a 40-50% urea compound is painless and useful in patients with very thick nails
  • Removal of the nail plate should be considered an adjunctive treatment in patients undergoing oral therapy.
  • A combination of oral, topical, and surgical therapy can increase efficacy and reduce cost.

 Further Outpatient Care

Adverse effects on the liver are possible with oral anti-fungal agents and therefore periodic monitoring of liver functions should be done through blood tests.
Treatment may be discontinued after standard dosing when no evidence of fungal infection (by microscopy or culture) is present. Nails may continue to look dystrophic after a cure is achieved in the laboratory.
After antifungal therapy, disease-free nail growth should be measured at every visit. Nails should grow at a rate of 1.5-2 mm per month and may take up to 1 year to look normal. A clinician may consider an additional dose of antifungal medication if the outgrowth distance slows or stops after discontinuing therapy.

To go to Frequently Asked Questions on Nail Fungus Removal Click Here

 

Appointments

Please contact us at 203-281-5737 or by using our contact form for an appointment or for additional information.

Before & After

Click on Image to enlarge