Laser Care For Onychomycosis: Can It Be Effective?

John Mozena, DPM, and Brent Haverstock, DPM, FACFAS

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    Candida species have emerged as second-line pathogens. Onychomycosis due to Candida (candidal onychomycosis) occurs increasingly in individuals who have defective immunity.9 Such immunity can be consequential to aging, diabetes, vascular diseases, HIV infection and drug therapies such as immunosuppressive therapy and broad-spectrum antibiotics. Non-dermatophyte mold infections are becoming more prevalent with the Aspergillus and Fusarium species commonly isolated.10

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