Laser Care For Onychomycosis: Can It Be Effective?

Start Page: 54
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Author(s): 
John Mozena, DPM, and Brent Haverstock, DPM, FACFAS

1. Charis MA, Elewski BE. A historical perspective on onychomycosis. Dermatological Therapy 1997; 3:43,
2. Elewski BE. Tinea pedis and tinea manuum. In: (Dermis JD, Ed) Clinical Dermatology, third edition, JB Lippincott Co., Philadelphia, 1993.
3. Drake LA, Scher RK, Smith EB, et al. Effects of onychomycosis on the quality of life. J Am Acad Dermatol 1998; 38(5 Pt 1):702.
4. Brenner MA, Harkless LB, Mendicino RW, et al. Ciclopirox 8% nail lacquer topical solution for the treatment of onychomycosis in patients with diabetes: a multicenter, open-label study. J Am Podiatr Med Assoc 2007:97(3):195-202.
5. Tosti A, Piraccini BM, Stinchi C, Colombo MD. Relapses of onychomycosis after successful treatment with systemic antifungals: a three-year follow up. Dermatology 1998; 197(2)162-166.
6. Joseph WS, Mozena JD. Podiatric approach to onychomycosis In: Scher RK. Daniel CR (eds) Nails: Diagnosis, Therapy, Surgery, third edition, Elsevier Saunders, Philadelphia, 2005, chapter 18, pp. 133-140.
7. Available from: www.nomirmedical.com/news1.pdf
8. Available from: www.patholase.com/news/multi-center-trial
9. Bornstein E. A review of current research in light based technologies for treatment of podiatric infectious disease states. JAPMA 2009; 99(4):348-52.
10. Mozena JD, Mitnick JP. Emerging concepts in treating onychomycosis. Podiatry Today 2009; 22(10):46-51.

   Editor’s note: For further reading, see the June 2004 Podiatry Today supplement “Managing Onychomycosis” or “Emerging Concepts In Treating Onychomycosis” in the October 2009 issue. To access the archives, visit www.podiatrytoday.com.

No. This author says a simple search of the literature fails to provide adequate support for lasers as an effective means of treating onychomycosis.

By Brent Haverstock, DPM, FACFAS

As podiatric physicians, we all encounter onychomycosis on a regular basis with patients presenting with a complaint of pain or dissatisfaction with the appearance of their nails.
Onychomycosis is a fungal infection of the toenails and fingernails that results in discoloration, thickening and splitting of the nails, and lifting of the nails from the underlying nail bed.

   The disease, which is most frequently caused by dermatophytes, has a high incidence within the general population, especially among older individuals. It has been estimated that onychomycosis affects 2 to 3 percent of the general population in the United States and 6.5 percent in Canada.1,2 The condition affects children much less commonly with an estimated prevalence at less than 2.6 percent.3 Males are more commonly affected than females.

   Those with diabetes mellitus have a higher incidence of the condition and the dystrophic nail can result in increased pressure.4 This pressure leads to subungual ulceration, which often requires a partial or complete digital amputation.5 There is also evidence to suggest that fungal infection of the foot is a risk factor in the development of lower limb cellulitis in individuals with diabetes.6

   Onychomycosis may be caused by one of three classifications of fungi: dermatophytes, yeasts and non-dermatophyte molds. Dermatophytes represent the most common group isolated from nail cultures with Trichophyton rubrum or Trichophyton mentagrophytes as the infecting organism. Trichophyton rubrum originated in West Africa, Southeast Asia, Indonesia and Northern Australia and spread to Europe, North and South America in the late 19th and 20th centuries.7,8

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