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PACT for fungal nails

Discussion in 'General Issues and Discussion Forum' started by jos, Aug 29, 2013.

  1. jos

    jos Active Member


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    Has anyone had experience with the light (PACT) therapy for fungal nails? Any comments?
     
  2. RSThorogood

    RSThorogood Member

    Hi Jos,

    We use it in our clinic.
    Positives:
    It is easy to use, has no pain for patients & has no systemic effects.
    Negatives:
    Requires minimum 4 appts per nail.

    To my knowledge, there are no current RCT's on it's efficacy, but anecdotal evidence from various podiatrists in Melbourne, Australia seems to suggest around 80% success rate.

    Regards,
    Robbie
     
  3. Paul Bowles

    Paul Bowles Well-Known Member

    Hi Robbie - can you post some pre and post shots for us to look at? How does it work?
     
  4. RSThorogood

    RSThorogood Member

    Hi Paul,

    Sorry I don't have any photos at the moment.

    In terms of the way it works, I haven't got the Practitioner manual nearby, but the dye marks the fungal cells and then the light is set at a wavelength which in combination with the dye destroys fungal cell walls, thus causing fungal cell death.

    Another negative is the potential for re-infection of the nail down the track as the nail will still be damaged (from initial repetitive microtrauma/previous infection) and therefore more susceptible to future infection.

    Regards,
    Robbie
     
  5. Paul Bowles

    Paul Bowles Well-Known Member

    ...this is the issue I have with this treatment - i've heard about it now for months but when I ask anyone for their clinical patient photos there don't seem to be any available...

    I'm not pointing the finger at you here RSTThorogood so this is not solely aimed at you personally, so trust me im not trying to offend or upset you here. Its simply the way it has to be - surely someone somewhere has some clinical data on this!

    Now there may be a logical reason no one can give me a good series of clinical photos regarding this treatment regime: 1) It doesn't work.... 2) It hasn't been around long enough for people to get photos 3) It just doesn't work! 4) No one who owns one of these units is on Podiatry Arena 5) It really just plain old doesn't work.....

    C'mon people we are here to share information and results. If you have it - please share it! Good, bad or indifferent.....no one is here to judge you on your clinical results using a certain treatment method.
     
  6. harpsy

    harpsy Member

    I have a Pact machine for sale, cheap if anyone is interested!
     
  7. Zac

    Zac Active Member

    Harpsy, does that mean you did not achieve positive results. I had also heard people were getting good results but I had also not seen any before/after images.
     
  8. Julian Head

    Julian Head Active Member

    excilor seems to be the best thing at the mo - much better than PACT, laser and amorolfine (curanail)
     
  9. blinda

    blinda MVP

    That`s very interesting considering that Excilor does not contain anti-fungal medication. Taken from their website;

    Do you have any published data, Julian?

    Cheers,
    Bel
     
  10. Julian Head

    Julian Head Active Member

    theres no published data at all that i can find.....i have used it for 9 months now in our practice and virtually all our patients who failed with laser at other practices and curanail in our practice have had resolution.....

    definitely one to be trialled I'd say....

    it makes the nail pH acidic btw
     
  11. blinda

    blinda MVP

    Thanks. Yes I knew it adjusted/increased pH, which is what I find interesting. When you say resolution, is it clinical or mycological cure?
     
  12. blinda

    blinda MVP

    Hi Paul,

    You`ve probably seen the attached brochure with `case studies`, but thought I`d post it anyway. As far as I can tell, there aren`t any other published studies.

    Cheers,
    Bel
     

    Attached Files:

  13. timberh

    timberh Member

     
  14. timberh

    timberh Member

    Hi julian,
    was wondering how your patients use this product. Is it necessary for the podiatrist to reduce the nail or is it an entirely home use product.
    would you agree that fungal infection can come from inside the body and therefore systemic treatment at the same time is a good idea?

    thanks julian
     
  15. Fungal nails are starting to be really really common and i hate not being able to offer a decent option to patients. I find excilor is the best after 1plus years of trying it with patients but its VERY slow and people don't want something slow. I initially got great results with Cannespro where i actually did the treatment every day for 2 weeks on the patients and drilled the nail down every day for them but not everyone can come in every day for 2 weeks which is a pain. I had the rep out yesterday showing me the clearanail drill. I was impressed with its research but when i used it, it isn't a great machine, seems temperamental however it was easy to use and was pain free so will be interesting to see the patient back in 4 and 8 weeks to see if it works. Has anyone tried it before or have any feedback on it? Ive attached the info i got on it. Hopefully someone has seen it and used it as i dont want to buy it without getting some good feedback
     

    Attached Files:

  16. thekwie

    thekwie Active Member

    So, a couple of years down the track from the original post:

    PACT: useful adjunct therapy or useless, practitioner-time-wasting, patient money/time wasting gimmick?

    After using for just under 12 months, I'm afraid I'm falling into the second category - really only one successful outcome. I'm still inclined to recommend Loceryl or Excilor to my patients.
     
  17. prokan

    prokan Welcome New Poster

    Hi , I have been using the pact since it came out , and have had had a great learning curve in regard to nail fungus understanding- pathology- classification of severity and treatment with the pact. I have been happy with the results. But as all treatments it has its limitations , that is In regard to severe infections in populations of elderly and sick patients. Sick being those with medical history as diabetics , immune suppressed , vasc. Insufficiency , blood disorder etc. . When I say severe, you need to be aware of the onychomycosis severity index for the appropriate definition , a reliable way to classify onychomycosis, this helps me to advise patients time it may take to clear the fungus and the difficulty involved in the more severe infections.
    "A New Classification System for Grading the Severity of Onychomycosis
    Onychomycosis Severity Index FREE
    Caitlin Carney, MD; Antonella Tosti, MD; Ralph Daniel, MD; Richard Scher, MD; Phoebe Rich, MD; Jamie DeCoster, PhD; Boni Elewski, MD"
    Mild to moderate case go very well with pact . It is just those in worse case scenario with both dermatophytoma and > 2 mm hyperkeratosis thickening( see article above) and infection down or close to matrix all in the one nail , and this is the case in the majority of their nails ( say 8-10), these cases are very difficult even in young healthy individuals . I think you will find this will b similar to laser outcomes .By the way their is no literature on laser outcomes with this classification of infection, as such cases are always an exclusion criteria.!! I have had patients in this classification attend whom have failed at laser at other clinics.The only thing here that can help is to use terbanifine tablets for the 1st 3/4 months to clear the matrix and I then continue pact until their are no more severe presentations and any mycotic infection is well distal from the lunula region .Of course not all patients want to go down this route, and ocassionally some can't tolerate the tablet .i have had a few that wanted to do the pact with this classification but refused to combine with the tablet and they have had substantial improvement , but it was a long haul 12-24 months( the patient here was warned of the difficulty and potentially long time it could take) . Approximately 70-80 %improvement in visual appearance and clearance but there are always 1-2 nails out of the 10 in these cases,where it's difficult to clear( usually these nails apparently seem to be the first infected). I have had some suprisingly fast clearances in some younger individuals with worst case scenario infections ( approx 4-5 months) but they had less no . of nails infected. Hope this gives you all a better understanding of how effective pact treatment is. Also on a note , the concept is nothing new , discovered before discovery of antibiotics , and used against cancers,bacteria and even in macular degeneration. So concept is well proven , the question is how well it works on toe nail fungus. As with any fungal toe nail treatment pedantic fungal toe nail debridement is key. Overall , as with any modality of toe nail fungus treatment process is usually slow ( except with very mild case)because of slow growth of nails.
     
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