Laser Treatment For Toenail Fungus [Laser Toenail Fungus Removal]

What are the standard toenail fungus treatments?

Treatment depends on the type of fungus and the severity of the infection. Your doctor may try one thing or a combination:

Oral antifungals, such as terbinafine, itraconazole, or fluconazole ( for 6-12 weeks).

• There are effective but may cause serious systemic side effects ranging from upset stomach and dizziness to severe skin problems and jaundice.
• The result is seen when the nail grows back completely while the success rate is usually low in the age above 65

Laser: Unlike other remedies that provide limited relief or require multiple doses and applications over a period of weeks and months, toenail fungus laser treatment can take as little as one treatment session, with a very high efficacy rate.

• At Prime foot & ankle specialists, we use laser toenail fungus treatment to help remove toenail fungus from our patient’s toes. We have seen good results that are backed up by the scientific literature.
• Toenail Fungus & Ingrown Toenail Surgery:

Depending upon the severity, the doctor can suggest surgery which may be:

1. Temporary removal:

Surgery may temporarily remove the nail to apply the antifungal drug directly to the infectious site under the nail. We generally use this approach with an infected ingrown toenail or a damaged bleeding toenail. It is an excellent treatment option with excellent overall results.

2. Permanent removal:

Some fungal toenail infections do not respond to topical or oral medicines, so that doctors may suggest permanent nail removal depending upon the severity of the fungal infection. Click here to learn more about permanent ingrown toenail removal procedures.

What is the best treatment for fungal toenail infections?

Laser treatment for toenail fungus has the highest efficacy and clearance rates, as published in clinical studies.

Both hot and cold laser therapy are found to be more effective and safe than topical anti-fungal creams and ointments, as well as oral medications.

How is a laser used for toenail fungus removal?

• Laser toenail fungal removal is a modern and safe treatment option for removing and preventing future fungal infections.
• It is the most effective and less harmful way.
• A precisely directed laser can eliminate the fungus without doing any harm to the surrounding nail tissues.
• The underlying technologies are already used for various other conditions, like cataract surgery, dental work,  hair removal, with proven excellent results and safety.
• Laser therapy is also approved by the U.S. Food and Drug Administration, FDA, to treat fungal infections of the toenails.

 What are the types of laser treatment for fungal nail infections?

Two types of lasers using different types of laser energy are used for the treatment:-

Thermal (hot) laser treatment:

• The laser device emits pulses that easily and effectively penetrate the nail, generating heat at the site of infection beneath the nail plate.
• CO2 lasers or pinpoint foot laser which uses YAG lasers with a wavelength of 870 nm, 930 nm, or 1320 nm are used to increase the localized temperature.
• Due to heat, the infected tissue is gasified and decomposed, destroying the fungus causing the infection.
• The heat from the lasers also has a sterilizing effect, which inhibits fungal growth.
• The treatment is usually painless, and only a warm sensation is felt at your nail.

Cold laser fungal nail treatment:

• It uses two low-level light beams ( red and blue) produced by a lunula laser, directed simultaneously on the nail to damage the living fungus and help your body clear the infection.
• The frequency of laser beams does not generate any heat, hence called ‘cold’ lasers.
• This treatment is safe, pain-free, and without any side effects.
• Laser nail treatment has several advantages over topical and oral anti-fungal.

PROS of laser for toenail fungus treatment:

1. Safe, painless treatment, so anesthesia is not required.
2. No recovery time, walk-in, and walkout.
3. The procedure usually requires only 15 minutes on both feet if all 10 nails are to be treated.
4. No side effects of drugs are required.
5. No liver enzyme tests are required.
6. It is 85% – 90% effective.
7. One laser treatment session is enough to eliminate the infection in 90% of cases. The remaining 10% may need 2 or 3 more sessions.

CONS of laser treatment for toenail fungus:

The cons are the rapidly changing technology.

This means that studies do not reflect the current technology updates.

This also means that even though it is FDA approved, insurance does not yet cover laser toenail fungus removal.

Disadvantages of medications:

1. Oral medicines such as Terbinafine have high efficacy.
2. Still, it has severe systemic side effects, including elevated liver enzymes, which must be checked before and one month after using oral medicines.
3. Topical medications are effective but take a long time to show results( 1 year or more).
4. They are to be applied twice daily, so most patients become non-compliant after regular use of 1 or 2 months.

How is Laser treatment performed?

• Before the appointment, Remove nail polish or decals from nails
• Before the procedure, technicians may file your nails to prepare the area for the laser.
• The foot is then cleaned using a sterile solution.
• The laser is maneuvered over the affected nail.
• Pulsing the laser or using selected wavelengths helps minimize the heat effects of laser on the skin and reduces the side effects.
• The procedure usually takes 15 minutes.
• Treatment is usually painless, but as the tissue decomposes, the chances are that warmth or tingling and rarely pain and/or bleeding can occur, but the skin heals in a few days.
• After the toenail laser treatment, most patients exhibit new nail growth without any damage to surrounding tissues. It usually takes 6 months to 1 year to return to a normal, healthy-looking nail.
• A cosmetic restoration procedure can also be performed over the existing nail to restore a healthy-looking appearance until the time a new nail grows and takes the place of the infected nail exiting out.
• Even though the fungus is eliminated by laser, there are still chances of recurrence. However, with a continued weekly application of a topical antifungal polish, re-infection is unlikely.
• Toenail fungus worsens and spreads with time. Treatment must be initiated as early as possible to avoid any complications.

How many laser treatments to remove toenail fungus?

• The number of laser sessions depends upon:
  • The number of infected nails
  • The severity of the fungal nail infection
  • Age
  • General health.
• A series of 3 to 4 treatment sessions over a 3 month period is recommended. The treatment is typically 5-15 minutes and spaced 4 – 6 weeks apart.
• This duration is essential to eradicate all fungal spores that may bloom after the initial laser therapy.
• However, significant improvement is usually seen after the first laser therapy session.
• As nails are non-living cells, they have no potential to fight off an infection and heal.
• So, once the fungus is destroyed after laser treatment, the damage is still irreversible.
• A healthy nail starts growing out.
• Damage slowly begins to disappear in 6 months to 1 year.
• We would also jumpstart this process by pre-treating your toenails before this therapy and we would also treat them after therapy.

How does Laser Treatment work?

              Laser treatment for toe-nail fungus works by targeting the site of infection, producing heat, and directly attacking the offending organism without any damage to skin and tissues.

It penetrates well, inhibiting the fungal growth, and some of the fungal microorganisms are destroyed.

What are the signs of improvement after laser treatment?

The infection resolves after a single session in some people, but some require additional sessions depending upon the results. To see complete results, it is important to wait till the complete growth of the new nail.

Signs of improvement include:

• The disappearance of nail discoloration
• Resolution of debris being build upon or under the nail
• Growth of new nail without any abnormal thickness, distorted shape, or bumps

What are post- laser toenail fungus treatment protocols to be followed?

 Care is taken after laser therapy to prevent new fungal growth, which includes:

• Treating shoes & skin with anti-fungal agents.
• Apply anti-fungal creams on and between the toes.
• Use an anti-fungal powder if feet sweat excessively.
• Use clean socks and change shoes to wear after treatment.
• Keep nails trimmed and clean.
• Stainless nail instruments should be sanitized by boiling in water for a minimum of 15 minutes.
• Choose salons where types of equipment are sanitized properly before every use.
• Wear flip-flops in public places.
• Don’t wear the same socks and footwear on consecutive days.

What are the Possible side effects of laser toenail fungus therapy?

Most patients experience no side effects except warmth during the procedure or a warm sensation after the procedure.

However, some patients may experience one or more of the following adverse effects:

• Feeling of warmth.
• Slight pain during treatment.
• Redness of the treated skin around the nail lasting for 24 to 72 hours.
• Slight swelling of the treated skin around the nail lasting for 24 to 72 hours.
• Discoloration.
• Burn marks may occur on the nail.
• Rarely, blistering of the treated skin around the nail.
• In some cases, Scarring of the treated skin around the nail may occur.
• While the laser treatments are most effective for fungal infection of toenails, the time commitment of making multiple appointments for repeating laser treatments and high cost could be a burden for the patient.

What is the 2021 success rate for Laser treatment of fungal toenail infection?  

• Lasers are being used extensively for the treatment of toenail fungal infections. Many clinical trials and studies have been done
• 2021:
• According to a recent study published in the Journal of Cutaneous and Aesthetic Surgery 14 (1), 93, 2021, YAG laser is effective in inducing nail clearance in onychomycosis (fungal infection of the toenail) and is better than antifungal therapy¹
• Data showed 90% success rates with the use of the latest generation laser equipment, done for a period of 3 months 95% of the patients were cured when treatment was extended for another 3 month period. While common anti-fungal medication used over a period of several months resulted in a cure rate of only 40% to 80%.
• 2019:
• A 2019 study published in the Journal of American Family Physicians by the American Association of Family Physicians found that after 180 days of toenail fungus laser treatment, patients had a 30% cure rate and a 91% improvement in symptoms. The AAFP study also concluded that laser treatment is more effective for fungus removal than both over-the-counter and prescription topical and oral antifungal medications.²
• 2018:
• In 2018, the Journal of Lasers in Medical Science published a study about the efficacy of laser treatment for fungus removal. These researchers reported a success rate of 83.7% among the patient population, who had infections that affected at least two-thirds of the nails³
• In another recent study, conducted on 72 patients for a period of 3 months, follow-up showed that in over 90% of the patients, total elimination of fungal infection resulted.

Effectiveness of toenail fungus laser treatment:

• Laser treatment for toenail fungal infections is a very effective and safe method. Still, the effectiveness varies depending on age, general health, duration, the severity of the infection, and degree of nail damage.
• Researches show up to 88% effectiveness though we expect around 50-78% to be more reflective overall.
• The nail can be removed and treated as the new one grows back in some persistent or severely infected nails.

Cost:

• The amount for treatment is typically charged per foot. This includes follow-up evaluation and treatment if required, within a period of 1 to 3 months.
• The per-foot cost is on average $600 for a 3-month plan and $800 for both feet. If the nails are to be removed, then an additional $100 depending on the number of nails to be removed

Toenail fungus prevention:

Following habits can help in preventing nail fungus :

• Wash your hands and feet regularly. Dry well and moisturize.
• Wash your hands after touching the infected nail.
• Trim nails straight across and smooth the edges with a file. File down thickened areas of nails.
• Disinfect your nail clippers after each use for about 15 minutes in boiling water.
• Wear sweat-absorbing socks and change socks regularly
• Choose shoes made of materials that let air move through them, like canvas, mesh, or leather.
• Either discard or treat old shoes with disinfectants or antifungal powders.
• Wear waterproof footwear in pool areas and avoid being barefoot in locker rooms.
• Go to nail salons where sterilized manicure tools are used for each customer.
• Give up nail polish and artificial nails. You might be tempted to cover up discolored nails with polish, but don’t because the nail bed can’t “breathe,” which keeps fungus from going away.

References:

1. https://pubmed.ncbi.nlm.nih.gov/34084015/
2. https://www.aafp.org/afp/2013/1201/p762.html
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5911271/