Toenail fungus, otherwise known as onychomycosis is both a cosmetic and medical condition of the nail. It has proven to be very difficult to treat in spite of numerous new antifungal drugs on the market. It is particularly problematic for women wishing to wear open toe shoes or sandals. The nails appear thick, yellow with fungal debris under the nail plate. Diabetic patients with fungal nails are more likely to develop ingrown nails or even ulcerations under the nail plate. So it is a real problem .Recently lasers have been introduced as a new treatment for onychomycosis with the idea of avoiding lengthy topical treatments or potentially dangerous oral medications. This modality is being sold to patients as a new "magic" bullet that can rapidly treat the most difficult cases of onychomycosis. Laser treatment of onychomycosis isn't covered by any insurance and the average cost per treatment of ten toes is approximately $2,500.So it merits that we ask the question, does it work.

Laser treatment consists of using a specific single low energy wavelength to cause photo damage to the fungal infection in the nail. The treatment is done in the doctor's office and requires no anesthesia as it is not painful. The laser light is applied directly to the nail being treated. The average treatment period is usually between 5 to ten treatments. There is also a maintenance plan of care required where a patient most come within the year for retouch with the laser due to possible flare up of the infection.

The manufacturers claim that they have studies demonstrating an 87% cure rate. The problem with their studies is that they are very small, sometimes using about ten patients. They also use cases where the nail had less than 50% of the plate infected. I conducted a Medline search of recent independent studies regarding real cure rates of onychomycosis using laser modalities. What I found for the most part is that other than the studies sponsored by the laser manufacturers. There are no extensive studies supporting the any real eradication of onychomycosis using lasers.

So are some patients getting "cured" with laser therapy and if so why?

The answer to these questions is probably yes. How are some patients being cured of their onychomycosis with a laser regimen given what I have just told you? The answer to this dilemma lies in the actual treatment plan most laser manufacturers outline for the practitioner. They all require that the patient be on anti-fungal prior and during the treatment plan. One of the best known manufacturers even recommends the patient be on an oral antifungal medication during the laser protocol.

I thought the reason for the laser was to avoid the cost, time and potential hazards of these medications.

So what is a patient with onychomycosis to do?

Go to a doctor who will do a fungal nail culture in order to confirm diagnosis of onychomycosis and to determine the type of organism that it is. Not all fungi are the same. If it comes back negative for fungus. Then other tests can be conducted to determine what is causing the nail pathology. All these tests usually yield specific agents that can specifically kill the pathogen causing the infection. The patient must insist that the doctor evaluate, diagnose and treat their onychomycosis the same way one would expect any infection to be treated.

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Written by Dr. Rick Reyes