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New Clearanail Drill information request

Discussion in 'United Kingdom' started by Gareth Mcmullan, Apr 23, 2015.


  1. Members do not see these Ads. Sign Up.
    Hi All, just reading the literature on the new drill for treating fungal nails. Has anyone used it yet or seen it in use? Its called clearanail, and is currently retailed by Algeos. The research looks very promising on it and its affordable to buy at around £2000. Would love you know if anyone has had good results from it?

    I have attached the research paper on it for anyone interested

    Thanks, Gareth
     

    Attached Files:

  2. Catfoot

    Catfoot Well-Known Member

    Hi Gareth,
    Everyone knows that the nail plate presents a barrier to drug absorption but I can't see why this nail drill should be any better than any other?? There is a limit to how far you can reduce a mycotic nail without the patient jumping out of the chair.

    I'm not convinced but no doubt others will give their 6 penneth....

    regards

    Catfoot
     
  3. Thats exactly what my first thought was. The difference is, with ordinary spray drills/nail drills, the smallest drill bit available is 1mm, these drill bits are 0.4mm which is very small, meaning the holes are drilled very fast and with the drill designed to stop when sensing a change in surface tension it should stop once through the nail, thus preventing pain.

    Like you however, i am skeptical so im hoping someone has used it and can let me know their thoughts.

    I see its Ivan Bristow who did the research and i know he is very highly respected in dermatology which is why im intrigued about the new machine. But in theory if we can make 30-40 holes in the nail plate and allow the Terbenifine to penetrate into the nail bed/matrix then surely this could be a vary successful treatment option??
     
  4. Lab Guy

    Lab Guy Well-Known Member

    If surgical avulsion of the nail plate with topical and oral anti-fungal medication is not effective the majority of time in clearing up mycotic nails long term (I repeat, long term) than why should clearnail? If you happen to find anything that works long term (2 years or longer) over 50% of the time, let me know.

    Steven
     
  5. Really? I find total nail avulsion with oral antifungals to be very effective, i just find it difficult to convince patients to have it done as most of them dont like the thought of needles and or having their nail removed, ha. But in general for the ones that do get it done, i find it very effective. Interesting that you reckon long term effects ie. 2years plus it returns. Do you have any research papers handy on it or is that just in your experience Lab Guy? Thanks for your reply
     
  6. barry francis

    barry francis Member

    We acquired this equipment some months ago so it too early for the results to be assessed. I am unimpressed with the results of lazer treatment(i have experienced it myself) and i consider the risk factors outweigh the benefits of oral antifungals. All of these comments are also linked to long term results. Nail removal carries the risk of permanent nail damage as well as the problems of allergy, possible liver damage, and gastrointestinal upsets, although these may be transient. If this approach is used my own results with topical agents gives reasonable results.
    Its vital that independant studies in this field are produced to underpin treatment.
    The clearanail treatment is validated by a good and scientific study although it is early days. Of interest to me though is that it is low risk, painfree, and seems to have a good rationale
     
  7. Lab Guy

    Lab Guy Well-Known Member

    Sorry for the delay Gareth. I do not have any research papers, it was just my experience with patients that had significant onychomycosis. I think a large percentage of patients have an impairment of their cellular mediated immunity making them highly susceptible to recurrence long term.

    Steven
     
  8. I understand recurrence is likely but aslong as the patient understands that, and is happy that it can come back in a month or in 6 months but that the clearanail does clear the issue, during this treatment process, then it has potential!? Rep is coming out tomorrow to let me see it and practice it so will see what i think of it then. Thanks for the replies guys
     
  9. clipper

    clipper Welcome New Poster

    Currently have treated 8 patients with varying degrees of mycotic infection, I take before and after photographs at 4 and 8 weeks respectively. The 3 patients I have reviewed at their 4 week review are impressed with their results in terms of improvement in color and an initial reduction in % of nail plate affected. In terms of usage the application of the micro drill has been pain free (have drilled 200 + holes in total to date) only twice has a patient experience mild discomfort and this was due to me drilling into non infected "normal nail" to act as a barrier to further infection, no discomfort has been experienced when drilling into damaged/infected nail. I invested in Clearanail as I was tired of doling out the same advice re taking tablets or using current paint on solutions which as we all know have limited success for a number of reasons.
    Yesterday I had a chap in clinic for his 4 week review, he had tired all the usual paint on solutions and was unable to tolerate Terbinafine tabs, as a result of the unsightly nature he was very self conscious and didn't show his feet in public ( nice look on the beach)

    Both 1st nails treated nails are clearer have greater integrity and during a recent visit for his NHS diabetic yearly check he was informed that his OM was no longer present. The patient is happy with the results particularly when using his initial pre treatment photo's as a benchmark, is now confident of bearing his feet during future holidays and his wife will no longer shout at him for wearing socks with sandles. I appreciate anecdotal stories do not add up to EBM. But to date I have found Clearanail to offer a viable alternative to exisiting treatments to be well tolerated and has resulted in an increase in patient consultations.
     
  10. Thanks for the reply clipper, thats interesting that you say the patient felt you drill the normal part of the nail as thats the only time i found my trial patient felt it aswell. I was really keen on the drill but i found it abit annoying that you can only drill for 30mins or 100 holes!! But i am going to give the patient i tried it on 4-6 weeks then review and if it works on them i will prob go for it as i am in the same boat as your self with giving out info on tablets or paint on solutions being very frustrating.
     
  11. Louelle

    Louelle Member

    Hi - any updates on how the Clearanail drills are doing?
    :)
     
  12. Connie D

    Connie D Member

    Barry, how can nail avulsion cause allergy, liver damage or tummy upsets?

    I have looked for the validated, scientific study you mentioned, but could only find the small case report of 5 subjects. Can you provide any others?
     
  13. I purchased a Clearanail machine last November 2014 and have now treated about 50 patients using it. All of them are showing signs of improvement with non-infected nail now growing from the proximal end of the nail bed. Big toe nails still seem to take around 9 to 12 months to clear and smaller nails around 6 months. Most patients I have treated about 3 or 4 times with the Clearanail and I get them to apply the Lamisil spray twice daily. I concentrate on placing a line of drill holes at the most proximal end of the fungal infected nail with the intention of stopping the already fungal infected nail spreading into the new nail growing in. The treatment even seems to work well for nails where the fungal infection is right beyond the eponychium. The treatment is described on the website as "virtually pain-free". Patients occasionally "ouch" during a drill hole but there is no blood and I conclude that as the drill bit gets hotter after several drill holes, the drill bit must drill through the nail plate and the hot point touches the skin below, creating an "ouch". I thoroughly recommend it.
     
  14. Lawrence Bevan

    Lawrence Bevan Active Member

    Jaqui

    What do you charge, are there consumables to be covered also? the website talks about single treatments not the 3-4 you mention in your experience

    thanks for your help

    L
     
  15. Jacqui, thanks for your info. I am finding great results so far with the clearanail also. However, I only do a one off treatment rather than the 2 or 3 you say? Are you finding that everyone needs extra treatments? Ive seen quite a few returns now who are 5 months since i drilled the nails and many of the the holes are still present, so I am just wandering why you are doing 2 or 3 treatments out of curiosity? I also recommend twice daily for the spray but tell the patient to do this for 2-3months!

    The "ouch" feeling I am told is because you are drilling a healthy part of nail rather than the heat. If you have someone with a small amount of fungal nail you can clearly see where it starts and stops you will often get the "ouch" feeling along the edge where it is clear, but that might not be true?



    Lawrence - the consumables involved are the lamasil spray and the "cutter". The cutter is the drill bit used for the treatment. Each drill bit is sterile single use and will only work for 30mins or 100 holes (due to the heat built up in the drill and drill bit, it is designed to only work for 30mins and cuts out automatically). This is abit frustrating as it is ?25 per cutter which ultimately only does 1 Big nail or 2 smaller nails but you only have 30mins to work with and 100 holes so you need to be fast. I have found total coverage of a big nail takes around 90 holes and smaller nails are around 50-60. So pricing depends on how many cutters you are using. The cutters are also very small (0.04mm head) and will snap very easy if patient jumps so you need to factor that in also.
     
  16. Lawrence Bevan

    Lawrence Bevan Active Member

    Gareth

    Thanks for sharing your experience.

    ?25 per single use cutter?? And from what you say you'll easily use more than one.

    Blows a bit of hole in the business model doesn't it?

    L
     
  17. Lawrence Bevan

    Lawrence Bevan Active Member

    duplicate post
     
  18. Ian Linane

    Ian Linane Well-Known Member

    Think you'd build that into your pricing at the outset Lawrence so should impact on profit margin, on the whole.
     
  19. Samt

    Samt Member

    Seems like every new bit of kit these days requires a token overpriced single use part. Cant help feeling like we're being taken for a bit of a ride. Cant really see why the drill bit cant be reused. Its made of the same stuff as my carbide cutter burrs, which are still as sharp as ever after a year or more of nail thinning.
     
  20. Lawrence Bevan

    Lawrence Bevan Active Member

    Certainly it's not mentioned in the product advertising or marketing!

    Wonder if the drill bit is autoclavable ?
     
  21. Samt

    Samt Member

    Should be. Tungsten carbide is one of the strongest, most hard wearing materials out there and can indeed be autoclaved. Many surgical instruments are made of it. i certainly dont think that such a tough material will spontaneously become useless after 30 mins regardless of how many holes it has drilled, so why the ?25 drill bit seizes to work after half an hour seems a bit of a mystery. I think we're really just buying the codes, rather than the drill bits. Perhaps we should set up a code swapping page.
     
  22. Suzannethefoot

    Suzannethefoot Active Member

    The single use for the drill piece is my bugbear too! It does seem to me that it is just a way of getting extra cash from practitioners on a regular basis! I have emailed for information about the drill and asked the question about the bits.

    Does anyone here have further results from patients? It has been some time now since people have started using them. Also, what do people charge? The website recommends between ?100 and ?150, but I'm assuming thats for 8 to 10 nails. What do people charge if it is just 1 nail, or both hallux? The ?25 for the bit is very expensive if you are doing just one treatment with it, but you have to put the serial number for each individual drill bit into the machine before you can use it!!

    Any imput would be great, as I have been caught before with wonderful advertising and enthusiastic sales people!!
     
  23. Suzannethefoot

    Suzannethefoot Active Member

    I wrote to the manufacturer to ask why he set the limit to 100 holes or 30 minutes, but he just fobbed me off and made no attempt to justify it at all!:mad:
     
  24. blinda

    blinda MVP

    Suzannethefoot;369644,
    Could you please post their reply to your question?

    Cheers
    Bel
     
  25. Suzannethefoot

    Suzannethefoot Active Member

    Hi Suzzane,

    Many Clearanail providers have two prices; one foot or both feet.

    You need to consider the cost of your time, which also needs to be paid for.

    Kind Regards,

    Rolf

    That was it!
     
  26. Suzannethefoot

    Suzannethefoot Active Member

    Just for clarification, this was my email to him:

    Dear Dr Thomas,

    Thank you for your reply. I understand that prevention of cross infection is a priority, but that is what autoclaves are for surely? And, if that is your concern, why does the drill bit only do 100 holes, or 30 minutes? It might take 130 holes, or 200 to do a single patient. It would be easy enough to stop drilling for a couple of minutes between toes to let the drill cool down. Many of the comments I have read from practitioners using the drill, complain that a single bur will not do a single patient if all nails are affected. I can understand your argument about cross contamination, just, but why 100 holes only? Surely the bur will not suddenly become blunt at 101 holes!

    If I do chose to buy one of the drills, do you provide a recycling facility for the burs, or know of a place that will recycle them? My local authority does not recycle this type of metal item. Just because we are getting used to being a disposable society, it does not make it right.
     
  27. Samt

    Samt Member

    Good email Suzanne. I sent a similar one a while ago and received a pretty fobby reply. But then I dont know what I expected him to say really ...I think I and everyone on this forum knows the answer to the 100 hole/30 min mystery already dont we? Would be funny if he was honest though. " Dear Suzanne, thank you for your letter, Im afraid we had to set the limit of 100 holes/30mins because I have my eye on this nice new car and would like you all to fund this and my early retirement to somewhere warm. Yours sincerely, Dr Rolf".

    Out of interest, could someone pop a "used" code on here so we can see if code sharing is an option. It will allow us to make one drill bit last for a whole treatment (which it should do in the first place), and in turn charge our patients a fair price. I would do it, but I no longer work at the clinic that offers the treatment and havent bought one for my own clinic yet. But I will based on the outcome of the code sharing experiment.
     
  28. Suzannethefoot

    Suzannethefoot Active Member

    LOL! Yes, I don't know why I expected anything else really. The price is an issue, but it really is the huge amount of waste that gets me!!!!:mad:
     
  29. Podiatrya

    Podiatrya Member

    Who said the smallest was 1mm? Algeos? Sure you can get 0.4mm drill from a dental supplier and your normal drill goes up to 30,000rpm which is VERY fast and helps prevent breaking with very small drills. Your hand should be able to sense when it has gone through the surface and you can then choose not to throw away a perfectly good drill bit after 100 holes.

    BUT why not forget this idea that will more than likely end up as an expensive ornament (another classic of the "sole distributor can charge whatever he likes" business model) and instead try removing ALL the infected nail with tungsten burs and applying your preferred topical to the nail bed. The fungus separates the nail plate from the bed so i find i can usually cut most of it away leaving me just the edge to remove with the bur. Where the fungus is in lines between non-infected nail i use very small ball end dental burs. You have to be careful but aren't we all having fine motor skills in this trade? I consider this a part of normal treatment which the patient has paid for by paying for my time.

    It works really well unless the fungus is in towards the matrix and not all of it can be reached, then it's less successful of course. So doing it at the first sign of infection makes sense otherwise i generally persuade the patient to live with it.
     
    Last edited: Nov 29, 2015
  30. Samt

    Samt Member

    Right. I now have a new machine at my clinic. Here is a used code, so if anyone wants to try it and let us all know if it works. If it does then maybe we could post our own used codes and finally remove the pain in the backside that is the 30min/100hole limit. Heres the code 1391981. Let us all know if it works.
     
  31. Suzannethefoot

    Suzannethefoot Active Member

    I would try, but mine has broken!!! :-(
     
  32. I might try sterilising some used drill bits, do I dare to extract them from my sin bin??? Right now Algeos are currently unable to supply new SUMs as they are having a problem with their supplier. That leaves me with a Clearanail machine and no SUMs to use on it, not great when I have to tell my patients I cannot continue the treatment!!!!! I've also had problems with about 10 SUMs which broke, so I had to use a second SUM cost to me almost ?30 including VAT, not cost effective to me! Altogether a little disillusioned with the Clearanail machine - but it does look as if it might work.
     
  33. Suzannethefoot

    Suzannethefoot Active Member

    I have the sum's but the drill does not work! I have only just got the drill and spent 100's of pounds advertising it, but now can't use it, as well as the thousands of pounds to buy it! Not pleased at all!!! I too have had good results so far from the few I managed to do before it broke, but I'm seriously out of pocket at the moment.
     
  34. fishpod

    fishpod Well-Known Member

    single drill bit codes machine only works with thier coded bits . smells fishy scam bull are you getting a nasty whiff. does not work / broke/ no sums sounds like a great product to avoid.
     
  35. Today's reply from Algeos
    "Good Morning Jacqui,

    It is with regret that we have to advise of a supply issue with our Clearanail product, and due to this, we are currently unable to issue you with a Clearanail kit and/or associated consumable items.

    Whilst we are working towards resolving this as quickly as possible, this does not appear likely until around the end of February 2016, therefore until this time it would be advisable to plan your Clearanail treatments around this situation.

    We recognise that this is not ideal, and can assure you that our teams are working on this matter as a priority. We will keep you fully informed as and when further information is available and thank you for your continued patience.


    Kind Regards,"
     
  36. Suzannethefoot

    Suzannethefoot Active Member

    I had exactly the same email from them on Monday! :-(
     
  37. blinda

    blinda MVP

  38. fishpod

    fishpod Well-Known Member

    Oh Dear left with useless expensive unusable kit. i would be looking for a full refund from algeos pronto.
     
  39. Medvice

    Medvice Member


    Hi Jacqui,

    I'm sorry that Algeos did not make you aware that you can now purchase SUMs directly from us.

    We can deliver very quickly.

    We will also support all current Clearanail users with any issues that they may have.

    Please direct any emails to the following address and we will be happy to resolve your issues as quickly as possible:-

    info@clearanail.com

    Kind Regards,

    Rolf
     
  40. daisyboi

    daisyboi Active Member

    Ok. So I'm still struggling to understand why we feel there is a need for a special drill for this. Your everyday drill will drill these holes for you no problem without the ridiculous costs and you can then use a topical to fill the holes. Can somebody explain to me what I am missing and why it can't be done this way?
    Thanks

    Dave
     
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