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Laser Comparison in treatment of Onychomycosis - Fungal nails

Discussion in 'General Issues and Discussion Forum' started by Foot11201, Jun 20, 2012.

  1. Foot11201

    Foot11201 Welcome New Poster


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    Hello,

    I am new to the forum and I was hoping to get some advice about the new Lasers that are on the market for the treatment of Onychomycosis. There are so many different lasers being marketed I don't really know which is the best.

    I have spoken to reps from Q-Clear, PinPointe, Fontana, Cool Touch and they all seem to claim that the other is worthless and they are the only ones that work.

    I also was wondering if anyone has ever used a New Star Cool Touch model n130 before in the use of treating Onychomycosis. It's an older model dated to april 2000. and its a 1320nm laser.

    Any advice on these lasers would be great! I keep doing research online but everything seems biased and there aren't very many published articles. I checked the JAPMA and nothing on laser comparisions.

    Any advice would be great! Thanks!
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. GabeT

    GabeT Welcome New Poster

    [Check4SPAM] RE: URL Attempt

    It is the wavelength of 1064nm that has proved to be successful in the treatment of onychomycosis. Studies across the board on different laser types all point to similar results of 70 -80% treatment success. The wavelength of 1064nm is used because it has little absorption in water and travels around 3mm into tissue with no tissue damage. As you start to get higher in wavelength, the absorption into water is higher meaning less depth penetration. The 1064nm depth is required to heat and pass the infrared light under the nail bed and kill the fungal colonies.

    Basically, all 1064 nm lasers need to be as efficient as each other.

    It comes down to price, portability, service and ease of use of the 1064nm laser unit you choose. ARC FOX 1064 is the top of the market on these points for onychomycosis treatment.

    http://www.arclaser.de/products/diode-laser/fox-diode-laser/
     
  4. Foot11201

    Foot11201 Welcome New Poster

    Thank you for your reply, there are so many on the market. its hard to choose
     
  5. Lab Guy

    Lab Guy Well-Known Member

    I think the laser is a billing device as it does nothing to treat the underlying etiology so recurrence is very high. If you buy a laser you should include in the price free laser treatments in event of recurrence.
     
  6. JaY

    JaY Active Member

    Hi Lab Guy - I somewhat agree with you in that you say recurrence is high. That is why I tell my patients to use something called Fungisolve which is a solution that they use to clean their instruments, socks, shoes, bed linen, bath towels and anything else that may have fungal spores. This will help to almost eliminate the potential for recurrence.

    However, I think laser (especially ARC FOX 1064) is the way to go nowadays. I work in a tropical climate and not a day goes by that I see patient's with severe fungal infections. :bang:
     
  7. Lab Guy

    Lab Guy Well-Known Member

    Durban, South Africa, cool place to live. I need to visit South Africa before I get too old.

    My gold standard of treatment for severe fungal nail infections is to remove the nail permanently. Even if all all ten nails are severely infected, I would remove all ten. The nail beds would thick and provide protection and they would never be tender in shoes or on ambulation (even in runners and ballet dancers).

    I would sharply excise the nail matrix under the eponychium and apply sodium hydroxide on the nail bed for a very short duration. Sutures for closure and dressing. Very little post-op pain and very happy patients.

    If I had severe fungal nails on all my nails, I would have them removed. I may be considered very aggressive, but I like to eradicate the problem as soon as possible when dealing with very thick onychomycotic incurvated nails. I think medication/laser is appropriate for mild cases.

    IMO, until we can discover how we can boost the immunity of our patients to treat and prevent recurrence, all conservative treatment is doomed to fail in the end.

    Steven


    Steven
     
  8. Lab Guy

    Lab Guy Well-Known Member

    Durban, South Africa, cool place to live. I need to visit South Africa before I get too old.

    My gold standard of treatment for severe fungal nail infections is to remove the nail permanently. Even if all all ten nails are severely infected, I would remove all ten. The nail beds would thick and provide protection and they would never be tender in shoes or on ambulation (even in runners and ballet dancers).

    I would sharply excise the nail matrix under the eponychium and apply sodium hydroxide on the nail bed for a very short duration. Sutures for closure and dressing. Very little post-op pain and very happy patients.

    If I had severe fungal nails on all my nails, I would have them removed. I may be considered very aggressive, but I like to eradicate the problem as soon as possible when dealing with very thick onychomycotic incurvated nails. I think medication/laser is appropriate for mild cases.

    IMO, until we can discover how we can boost the immunity of our patients to treat and prevent recurrence, all conservative treatment is doomed to fail in the end.

    Steven
     
  9. Paul Bowles

    Paul Bowles Well-Known Member

    Does that philosophy apply to bacterial infections as well? Or viruses? (outside of course immunization).
     
  10. Lab Guy

    Lab Guy Well-Known Member

    It is unclear to me what you are asking as mycotic nails are caused by a fungus.

    Steven
     
  11. Paul Bowles

    Paul Bowles Well-Known Member

    I was pointing out your ridiculous statement above. You implied we should reconsider treating until we can boost the immunity of our patients to treat and prevent recurrence. I was asking if the same applies to things like strep throat? Or any other bacterial, viral infections...... Recurrence is a part of life for most opportunistic infectious organisms. Your point doesn't make any sense.
     
  12. Lab Guy

    Lab Guy Well-Known Member

    I do not disagree with you although I think you misunderstood me. I wrote that for mild cases, to try laser and other conservative modalities. You are correct, recurrence is a part of life and thus for mild cases you want to try to preserve the nails as many patients want to keep their nails for cosmetic reasons.

    However, I wrote that for severely infected mycotic nails, I would permanently remove them. This means that the nails are so thick that they cause pain, are difficult to trim without discomfort and could have a foul odor from the debri under the nail. There is also a high risk for an ulceration of the nail bed that can result in osteomyelitis of the distal phalanx from the high pressure being directed from the toe-box onto the nail plate.

    If there was a treatment for the compromised cellular mediated immunity from causes such as impaired blood flow, diabetes, aging, trauma, genetics, ect. then we could try to save the nail. I use the word try, as once the nail becomes severely thickened, the high pressure in the nail root still causes damage leading to thickened and irregular nails.

    This contrasts with the treatment of a sore throat caused by either a virus or bacteria. After treatment, the tonsils and throat return to normal unlike a severely infected mycotic nail. Now, if a diabetic patient has a severe bacteria infection with bone involvement, I would be very aggressive in my debridement to salvage as much as the foot as possible.

    I am aware that our role is to preserve the anatomy that our patient was born with whenever possible. But for severe mycotic nails, we can throw away thousands of dollars on oral and topical medication and routine debridement for many years and still not cure the problem. Alternatively, if the patient is a surgical candidate, we could just perform a quick, safe and time tested procedure. When the patient gets very old, ingrown, painful mycotic nails will be one less problem to deal with as well as the potential sequela.

    I have no philosophy but to do what I think is best for the welfare of my patient even if it goes against the traditional standard of care.

    Steven
     
  13. Paul Bowles

    Paul Bowles Well-Known Member

    Possibly yes - your original statements were a little "lite on" so I may have misunderstood apologies. Thanks for clearing it up.
     
  14. Lab Guy

    Lab Guy Well-Known Member

    Yes, Paul, my original post emphasized permanent removal so I understand the misunderstanding. Thanks.

    Steven
     
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