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Laser treatment for nail fungus

Discussion in 'General Issues and Discussion Forum' started by Cameron, Jan 4, 2009.

  1. Tim Foran

    Tim Foran Active Member

    I think it improves every nail that I treat but it is hard to speculate why some become clear while others require ongoing treatment. Each patient I have found tolerates the laser differently. Some will say that they did not have any discomfort while another will say it got very hot. How they tolerate the treatment does not always correlate with how the nail responds down the track. I wish it would so I could give a better answer.
     
  2. Mart

    Mart Well-Known Member

    Thanks that's interesting observation

    cheers Martin
     
  3. peterk

    peterk Welcome New Poster

    Hi - we have made a little "quiz" app for Android that has some very basic questions to determine if someone might have a need for a consult re nail fungus.

    We are marketers, not podiatrists, and so this app is not very clinical - but it does spur some people to request a consult where we leave it up to you pros to help them further, if it seems appropriate to you and the patient.

    The app is intended to generate some new leads/referrals and as we're testing the model we'd appreciate feedback. So far we've had good feedback from consumers, which is the target audience.

    Oh and we have a few leads to give out, as we're starting to get a few coming in but have no one to send them to (they are 90% US and some outside USA).

    We'd be happy to connect these prospects with members who might be looking for new patients.

    I don't mean to hijack this thread so for more details and a current list of the leads pls see our thread here.

    Thanks,
    Peter
     
  4. Mart

    Mart Well-Known Member

    just read a good recent systematic review.

    http://www.jfootankleres.com/content/7/1/34/abstract


    mentioned within paper is what has been speculated in this thread

    "Studies on fungal nail clippings
    have demonstrated this to have a direct thermal killing
    effect on fungal mycelia when treatment temperatures
    exceed 50° centigrade [18]."

    This idea is consistent with the wide variability of anecdotal outcomes reported in this thread. I have speculated within my own experience, (which was primarily with "severe" infection) that the dose limiting factor of intolerance to heating was likely reason for failure. Because of extremely poor outcomes (no cure) I rejected using this technology in my clinic and will not recommend to patients unless further evidence showing reasonable efficacy emerges.

    In his review, Bristow pointed to the poor methodology used in majority of studies. I believe that we may not find good outcomes (high cure rates) unless we can overcome understanding the dose issue. Whilst anesthetizing toe would likely allow tolerance of a reliably heat destroying dose to dermatophytes it would likely have an unacceptable risk for host injury.

    I have speculated that if the effect of onychomycosis causes separation of nail from nail bed there may be a sufficiently heat insulating air layer present to allow adequately destructive temperature within the nail plate without host injury. This might explain why Tim Foran had success in the examples he posted.

    Another idea that I have not seen discussed is to investigate the effect a very short interval (ms) temperature exposure to in vitro onychomycosis. Because laser might be selectively "tuned" for photon energy absorption according to the pigmentation created within/around the dermatophyes it may be possible to heat those elements to very high temperature for very short time intervals with good effect without sufficient heat conduction to adjacent skin to cause injury to host. To achieve this might be largely a function of optimizing balance of pulse width and power output. Anyone aware if this approach has been considered or if it seems logically flawed?



    Cheers

    Martin

    Foot and Ankle Clinic
    1365 Grant Ave.
    Winnipeg Manitoba R3M 1Z8
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
    Last edited: Sep 30, 2014
  5. Paul Bowles

    Paul Bowles Well-Known Member


    I think you may find we discussed this many moons ago in this thread somewhere. We have data that shows debriding any onycolytic nail and applying the laser directly to the nail bed has very little success. Leaving the nail in place even in its lytic state seems to provide better outcomes.
     
  6. Mart

    Mart Well-Known Member

    Hi Paul

    Indeed we did, although I am unaware that this was reported by anyone but myself. I am canvassing opinion to see if anyone else has anything to add to that conversation at this stage given the apparent stagnation in well designed published studies in this area over the past year.

    Cheers

    Martin

    Foot and Ankle Clinic
    1365 Grant Ave.
    Winnipeg Manitoba R3M 1Z8
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  7. Paul Bowles

    Paul Bowles Well-Known Member


    We have all data collected, analyzed and reviewed - just needs writing up. You want the job? ;)
     
  8. Mart

    Mart Well-Known Member

    Haha ...... I would love to be able to responsibly say yes but if I did there would be yet another unfinished task relegated to the "en route to oblivion list" ....... But look forward to reading whoever does ... Good luck :drinks
    cheers Martin
     
  9. Paul Bowles

    Paul Bowles Well-Known Member


    LOL - thats the excuse I keep using. Everyone tells me its wearing thin!
     
  10. Blarney

    Blarney Active Member

  11. eanna

    eanna Member

    Hi Newsouth ,
    Following on from your post last year..." Awaiting for mine ...." Has it arrived and if so how are you getting on with ? Are you treating just nail problems with it ?
    Cheers Eanna
     
  12. Cumulus

    Cumulus Welcome New Poster

    I have a quick question about the various nail lasers. I'm trying to understand if any of the wavelengths used in the various lasers could potentially increase the risk of cancer, in particular, skin cancer.

    I have not seen this discussed anywhere. I'm wondering how you would answer a patient if they asked you this question?

    When a product is approved by the FDA or given CE mark, has the laser company been required to undertake studies that demonstrate there is no cancer risk?
     
  13. Suzannethefoot

    Suzannethefoot Active Member

    Laser treatment cannot be carried out on anyone who has had cancer of any type within a year, and not at all on anyone who has had skin cancer. If the patient has sunburn, then the treatment cannot be carried out until it has gone completely.

    I don't think we have to worry about the laser causing cancer, as long as guidelines are followed.

    I would be very interested if anyone has evidence to the contrary though!
     
  14. NewsBot

    NewsBot The Admin that posts the news.

    Treating onychomycosis with the short-pulsed 1064-nm-Nd:YAG laser: results of a prospective randomized controlled trial.
    Karsai S et al
    J Eur Acad Dermatol Venereol. 2016 Aug 13
     
  15. NewsBot

    NewsBot The Admin that posts the news.

    Evaluation of Nd:YAG laser device efficacy on onychomycosis: a case series of 30 patients.
    Helou J et al
    Mycoses. 2016 Jan;59(1):7-11.
     
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