Laser Care For Onychomycosis: Can It Be Effective?

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

What Promise Does Laser Treatment Hold?

Recently, the emergence of new technology has brought about another option for the treatment of onychomycosis. Podiatry is no stranger to laser surgery. Lasers have been in use for the last several years in our profession for warts, dermal lesions and matrixectomy of ingrown nails.    The newest laser application in podiatry is the ablation of a fungus infection within a toenail. Utilizing very specific wavelengths, the newer lasers are able to cause photo damage and/or ablation of the fungus within the toenail. The two lasers that I believe have the greatest potential are the Noveon laser (Nomir Medical) and the PinPointe FootLaser (PathoLase). Early studies with these devices show high efficacy rates.7,8    The Noveon laser uses an infrared light, which causes inactivation of the fungus. The Noveon’s two very specific infrared wavelengths have the unique ability to cause photo damage to microbes at physiological temperatures that can kill them directly or sensitize them to destruction.    The PinPointe FootLaser is currently undergoing a controlled multicenter study to evaluate its effectiveness. Early studies indicate a clinical response rate of 87 percent.8 There are other laser companies working on fungus destruction but those lasers rely on UVC light, which can have a higher cancer risk.9    The PinPointe FootLaser uses a single wavelength of light to cause destruction of the fungus cell specifically. The pinpoint laser light passes through the toenail without causing damage to the nail or surrounding skin. The laser has a proprietary pulsed beam that differentially abates pathogens versus healthy tissues, resulting in the inhibition of pathogen growth.    The patients receive safe, quick treatment with no drugs, no anesthesia and very little or no pain. The PinPointe FootLaser reportedly has minimal risks or side effects.8    Both lasers are currently being reviewed by the FDA for onychomycosis treatment and their respective treatment protocols. While neither currently has been cleared for a specific onychomycosis indication, the preliminary studies are very promising. Studies have shown not only good efficacy for the lasers but a high safety profile and good adherence as well since only one or a few treatments are required.10 Having a medical procedure that one can perform in one session can provide an enormous cost savings since multiple visits are not necessary.

Sharing Insights From Personal Experience As A Patient

I personally have tried topical, oral and laser treatment on the toenails on my left foot. I found topical medication only mildly effective. Since my onychomycosis is moderate to severe, topical medication is not indicated. Although oral medication did clear my nail significantly, re-infection occurred over time. I again tried oral medication but I experienced pain and tenderness in my liver area. I feel this may have been a gall bladder issue.    Finally, I tried the PinPointe FootLaser about one year ago. I found significant improvement, especially in my hallux nail. I believe another treatment may be required for a more complete clearing as laser protocols are continuing to develop. I also would not hesitate to have any further treatment with the PinPointe Foot Laser as any health risk seems to be almost nonexistent.

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