July 2010

New Study Shows Efficacy Of Laser Therapy For Onychomycosis

By Brian McCurdy, Senior Editor

Given the common prevalence of onychomycosis, the emergence of new laser devices to help treat this disease has been an intriguing development. A recently published study suggests that laser therapy may have a role in the treatment armamentarium for onychomycosis.

   Published in the Journal of the American Podiatric Medical Association (JAPMA), the study examined the use of laser therapy on 26 toes with mycologically confirmed onychomycosis. There were 10 mild cases of onychomycosis, seven moderate cases and nine severe cases. Researchers included patients with diabetes without neuropathy or peripheral vascular disease. The Noveon (Nomir Medical) treatments consisted of a four-minute exposure of simultaneously applied wavelengths of 870 and 930 nm and a second exposure of 930 nm for two minutes, according to the study.

   After a 180-day follow-up period, researchers found that 65 percent of the treated toes demonstrated at least 3 mm of clear nail growth and 26 percent showed at least 4 mm of clear nail growth, according to the study. The authors also noted that of the 16 toes with moderate or severe onychomycosis, 63 percent showed clear nail growth of at least 3 mm.

   Warren Joseph, DPM, sees “great promise” in using lasers for onychomycosis.

    “The ‘Holy Grail’ of onychomycosis treatment has been to develop a totally safe, effective, convenient and cost-effective therapy without the risks, as minimal as they may have been, of toxicities and drug-drug interactions that may be found with the use of oral agents,” notes Dr. Joseph, a Fellow of the Infectious Diseases Society of America. “Light based therapies have the potential to meet those criteria.”

A Closer Look At The Pros And Cons Of Lasers

Adam Landsman, DPM, PhD, the lead author of the study, notes two issues with onychomycosis treatment: penetration of the nail plate and the need to reach fungus hidden away at the nail root. He notes that historically, topical therapies focus on clever techniques to reach the fungus deep beneath the nail whereas oral therapies focus on an “inside-out” approach.

   Since oral antifungals rely on the liver for metabolism, Dr. Landsman says there has always been some concern for injury to the liver associated with oral therapy.

   Laser technologies appear to be much more effective at penetrating the nail plate and are thought to reach a short distance beneath the nail fold to damage existing fungus there as well, according to Dr. Landsman, an Assistant Professor of Surgery at Harvard Medical School in Cambridge, Mass.

   Furthermore, he says lasers can accomplish this goal with only one to four treatments and with none of the risks associated with oral therapy.

   However, Dr. Landsman does note some downsides to the laser approach. He cites the potential for burns to the nail bed, primarily associated with heat-based systems. With heat-based systems, he also notes the potential for nails that are free from fungus but retain a distorted appearance. He notes this can be due to chronic damage to the nail root, nail beds that no longer adhere to the nail or even nail distortion caused by the laser.

   Although thermal injury and distortion of the nail appear to be rare, Dr. Landsman says one should discuss the possibility of these risks of the laser procedure with potential candidates.

   In addition, he notes that lasers for onychomycosis are not currently covered by insurance and costs can be high in comparison to other topical or oral treatments.

   As Dr. Joseph notes, the Noveon clinical trial is the first on the subject to be published in the peer-reviewed, indexed literature. It remains to be seen if the published clinical results will be reflected in more generalized “real world” usage, comments Dr. Joseph, who is affiliated with the Roxborough Memorial Hospital in Philadelphia. He adds that he has been a consultant for Nomir Medical.

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