CONDITIONS AND TREATMENTS

LASER NAIL FUNGUS TREATMENT

There are many treatments available for nail fungus, and only a few successful ones are worth trying. Nail fungus infection is difficult to eradicate due to the cover the nail provides the infected tissue (which is actually the skin under the nail). Over the years, numerous new treatments have been developed and largely abandoned due to ineffectiveness or risk. The latest trend in nail fungus treatment uses laser to destroy the fungus and cure the infection. This treatment may hold some promise in safely and effectively ridding the nail of fungus. Unfortunately, our doctors are not currently satisfied with the research enough to confidently recommend the treatment to our patients. The following explanation details our concerns.

Laser nail treatment essentially uses the laser's energy to destroy the fungus cells. Traditional lasers used in dermatology applications create heat with the energy used for medical purposes. Laser nail treatment uses a different approach to deliver the energy under the nail surface without heating the nail tissue on top and causing tissue damage. There are essentially two different laser manufacturer's whose products are used for this treatment. A study was published last year in the Journal of the American Podiatric Medical Association trying to establish a scientific basis of the treatment's effectiveness. At first glance, the numbers seemed to indicate that laser nail treatment is effective. However, when the research is given a more scrutinized look, the numbers do not seem as promising due to several flaws. The first issue is the time the researchers spent following the treatment. The patients in the study were only followed for six months after treatment. This is not long enough to fully assess whether nail fungus is completely cured, as observation for nearly a year may be needed depending on the growth rate of the nail. The authors assessed fungal eradication at both the leading edge of the nail and the skin border where the nail grows from. The study shows patients had clear fungus-less appearing nails growing out several millimeters from the skin edge where the nail grows from eventually following treatment. This is often the visual marker that we use to determine how all fungal nail treatment is progressing, as it MAY indicate that fungus is dying and not invading new nail tissue as it grows. However, since the study only was conducted for six months, it is not clear if this represents real fungus destruction, or if it simply stunted fungal growth leaving live fungus still capable of destruction further down the nail. An additional microscopic study of the other edge of the nail showed actual fungus eradication rates to rise decently, but then inexplicably fall at 180 days. A longer follow-up time of a year or so might have given a better indication as to the actual longevity and effectiveness of the treatment.

The second issue our doctors have with the study is the limited number of patients enrolled in it. Small numbers of participants in a study can make for poor results. The more people studied, the more reliable the results become notwithstanding the rest of the design of the study. While there is no magic number that suddenly makes the results of a study of this kind more relevant, more participants would have made for a more convincing argument for this treatment.

Finally, this study was funded by one of the laser manufacturers, and is hardly considered independent research into a new medical device. This is not to say the results were skewed in favor of the treatment, it only implies that such studies need to be taken with a grain of salt and perhaps be scrutinized more for study design and claim accuracy.

In short, the research had too few people, did not follow the patient's long enough, and was brought to fruition by the people who stand to gain the most by the use of the laser instrument. This alone is enough for our doctors to sit back and wait for an independent, long term (at least a year) study with a large patient population. While this technique is generally harmless, the fact that treatment costs nearly $1000 in most areas (forget about insurance coverage) and may have to be REPEATED should give those considering it some cause for caution. In the end laser nail fungus treatment may end up being a revolutionary new concept. However, at this time our doctors are not willing to bet with our patient's pocketbooks as to how effective it really is in the long run, especially with the fact that there are several less expensive traditional treatment options that are generally safe and effective at killing fungus. These treatments include a combination of physician supervised oral and topical antifungal medications, as well as regular thinning of the nail thickness to improve treatment success.