Medical Laser Blog - Fotona Straight Talk for the Physician

Onychomycosis Treatment Success With The Fotona Nd:YAG Laser

Treatment options for onychomycosis are, right now, not very good. There are a couple of medications: a couple of them topical, but most of them oral. The oral medications carry with them some significant oral toxicity and you have to be on them for long periods of time. In fact, a 12-week course of oral anti-fungals carries with it about a 60+% cure rate for onychomycosis. In other words, 40% of the time the patient relapses.

We have done studies (we meaning the Fotona family of physicians) published in European journals that show a way better than 90% cure rate for onychomycosis. And I’m talking about culture proven cure rate of onychomycosis with no known toxicity. It’s quick and it’s easy. It’s done with Nd:YAG laser, fairly low power, and multiple passes – simply to heat the nail itself and the nail bed. The heat kills the fungus.

In our office we started doing this sort of as an out-reach of our treatment of other infections of other things such as acne and so on, and found it worked so well that basically, it’s the only way I treat onychomycosis anymore. We’re a bit different in our treatment. Consider that there’s a company that has a machine that ONLY treats onychomycosis and they advertise one treatment, one time – done. Well it turns out that that machine has a cure rate (with a single treatment) that’s approximately equal to the medications. I wasn’t exactly excited about being equal to the medications, considering 40% of the people who use the medications have relapse. So we do the treatment 2x/week for 2 weeks. Because of our computer-controlled scanner, we can do the treatments very, very rapidly, even if it’s all toes involved. Therefore, we don’t have to charge any more than the company that does the one-time treatment. So…same cost, a little bit of inconvenience to the patient because they have to come back a few times, but dramatically better results in terms of long-term curing.

It turns out that there are a lot of people with onychomycosis, and they hate it. They don’t want to wear sandals; they don’t want to go swimming in somebody’s pool because someone will see their nails. They don’t want their nails seen in public at all. They’ll file down their nails until they actually bleed just to make them look relatively flat and then they’ll paint them with several layers of polish in order to camouflage them.

Onychomycosis is in your practice right now and you may not know it. Less than 10% of people ask about being treated for onychomycosis. Of the 10% that do, only about half of those have insurance that will cover the medicine and the medicine is really expensive - far more expensive than a course of therapy with the laser. Consider the aesthetic laser treatment of onychomycosis. The treatment parameters are simple, it’s quick to do, and very effective. One more procedure that your patients are looking for and that you can provide.

Onychomychosis - Another Good Reason to Have a Medical Laser

But… it is a common problem that people are interested in treating.  The options for the most part are not so great:  take a med for about 3 to 6 months that has a significant toxicity.  In addition, the cure rate at 3 to 6 mo. is about 29%.  If you continue treatment for about a year, the cure rate is about 68%.

In comparison, with several hundred fungal nail treatments documented, our cure rate to date is greater than 90%.  This is without drugs and without serious toxicity.  We use laser.  With our computer-controlled scanner, we scan the nail and the surrounding tissue.  For about a 30% cure rate you could treat just one time.  We choose the 90+% cure rate (to date it is 100% in published papers) so we treat 4 times over 2 weeks.  The treatment is fast, less than 2 min. per nail, and well worth our time. Onychomychosis - just one more reason to include aesthetic laser equipment / laser medicine in your practice.

How is it done?  We scan the nail with a Nd:YAG laser (1064 nm), 3 passes at moderate fluence.  This is repeated 2 times a week for 2 weeks. Done.  Now just wait for the nail to grow out.  We tell all of our patients that if the nail is not clear when it grows out we will re-treat for free.  We have not needed to do that.  We are in a relatively small town so we only charge about $900.00 for one extremity.  If they have more involvement we may charge more.  Not bad for 10 min work.