Posted by Thomas Sult MD on Mon, May 24, 2010 @ 10:23 AM
As you know, athlete’s foot is a fungal infection of the superficial skin. It can sometimes be quite difficult to treat. The inflammatory response to the infection results in a thickening of the cutaneous layer of the skin, making it very difficult for the medication to penetrate deep enough to kill the infection in the deepest layers of the skin.
We have a solution to that problem. With the laser I use – the Fotona XP Max (or any Fotona Nd:YAG laser) - we use hair removal settings (or even a bit hotter) and use the computer controlled scanner to cover the area three times, being sure to get in all the nooks and crannies between the toes. We get good, deep penetration with the laser and that heats the tissues that are inflamed, resulting in sterilization.
We’ve had very good results treating foot fungus that have been multi-drug resistant. Especially the really thick heal calluses that are sometimes fungally infected and look cracked and broken and maybe have been filed off many times with a pumice stone yet always return only to be as bad or worse. We’re able to treat those very nicely and see good resolution of the thick callous and resolution of the fungal infection without ablation and without side effects.
Treating athlete’s foot with the Fotona Nd:YAG laser in our practice is a very nice ancillary treatment. When we first started our laser practice we didn’t do much of this sort of thing. But with our growing reputation for being able to resolve difficult-to-treat problems, people are coming into our office with toenail fungus, athlete’s foot, folliculitis, etc. As I’ve said in other blog posts, we’ve been able to close surgical wounds that had been left open secondary to infection and just never secondarily closed (they never granulated in). I’ve talked about a pilonidal cyst case and we’ve also had a case of a coronary bypass graft where the harvest sight for the saphenous vein just would not close and would not close. We started scanning it with the Nd:YAG laser and slowly over time it closed after being open for about a year. After about 3 months of Nd:YAG therapy it closed completely and the scar had healed very well.
The Nd:YAG laser, interacting with the inflamed tissue of the body, heats the tissue and results in sterilization of the tissue. The nice thing is that it doesn’t interact with the non-inflamed tissue so you can scan widely because when you're scanning an area that is non-inflamed there is little or no pain associated with it. When you’re over the inflamed tissue, it can get a bit hot, but you explain to your patient that when you feel that heat, it means you’re killing “bugs” and we’re moving forward.
If you’re interested in learning more, let us know. We’d be happy to walk you through the process!
Posted by Thomas Sult MD on Mon, Feb 01, 2010 @ 08:19 AM
We have had several interesting experiences with infection. Our early experience was in treating acne. We had great results with acne. In fact, our results with acne treatments are staggering. Next, we had several patients that complained of recurrent boils. We would scan them with the Nd:YAG laser and get complete resolution despite the failure of several I&D and antibiotics. We then had a family friend who had CABG surgery and his Saphinous vein harvest site wound would not heal. He was several months post op and several antibiotic and debridements into it when we first saw him. After a few scans the wounds healed up just fine. Later we started hearing about treating onychomycosis with the laser. We started treating it and found great results.
How can this be? Good question! The R&D department at Fotona looked into it and found that firing the laser at bacteria or fungus had no effect on them so it is not a direct toxic effect to the infection. What we have found rather, is that areas of infection are inflamed. Inflammation results in more blood supply and congestion. This blood is a good local target for the laser. The laser heats the blood and has several effects. One is to kill the bacteria by heat alone, another is to release immune modulating chemicals from the injured blood vessels. This results in a reduction in the infection by heat and an increase of the immune response locally.
So if you are treating a patient with an infection and scan over an area you will get intermittent reactions from them. They will be quiet and comfortable if you are over an area of no infection and no inflammation. When you move over the active infection you will get a “felt that one” response. Laser therapy for infection is self-selective and targeted.
Contact us to find out more!