Laser nail treatment refers to the use of medical grade lasers to treat onychomycosis. Onychomycosis is the medical term for fungal nail infection (onycho pertaining to nail and mycosis meaning fungi).
How common is onychomycosis?
Onychomycosis affects roughly 10% of Australian adults. The risk of infection increases significantly with age. Studies report an incidence of 15-20% in 40-60 year olds, 30% between 60 and 70 year olds and 50% of those older than 70 years of age. Toenails are affected more often than fingernails.
What are the features of Onychomycosis?
Onychomycosis may affect one or more toe nails and/or fingernails and most often involves the great toe nail or little toe nail. Common features include one or more of:
- Discoloured nails
- Distorted shape
- Thickened nail
- Brittle, crumbly or ragged nail
- Nail separated from underlying skin
- Yellow or white streaks in the nail
What causes onychomycosis?
Dermatopyhtes are the fungi most commonly responsible for causing this condition. Anyone can be at risk because fungus is present throughout the environment. Common sources of infection include swimming pools, gyms, public showers and nail spas. The risk of infection increases with age and also in patients with poor circulation and medical conditions such as diabetes. Some cases of infection occur following nail trauma.
Why is onychomycosis a concern?
Discolouration and/or distortion in the shape of nails can be a significant cosmetic embarrassment. Nail infection can also result in pain and discomfort which can lead to difficulty in normal activities such as walking, running or dancing. In some patients especially diabetics, there is an association with more serious infections such as cellulitis. Infected nails can also act as a reservoir for fungi which can be transmitted to other areas of the body and to other people.
Why use lasers?
Onychomycosis has been a very difficult condition to treat. Topical agents have been used and whilst safe and relatively inexpensive they are not particularly effective as they struggle to penetrate through the nail into the infected nail bed. Prescription oral medications can be effective but have the potential to cause unpleasant side effects, particularly to the liver and gut, meaning many patients cannot or will not use them. The need for a non-invasive, safe and effective alternative treatment led to the use of laser technology. Lasers are well known for concentrating light to produce heat and certain lasers can penetrate through nails to kill fungi by localised heating.
What type of laser is used?
The most common type of laser used to treat onychomycosis is called a YAG laser. This type of laser has a long wavelength enabling it to penetrate through nails and effectively target fungal overgrowth under the nail. When the laser energy is delivered as a short pulse (sub millisecond) it can provide controlled heating which is well tolerated. The lasers used to treat nail infection can be equipped with infrared temperature sensors which provide real time temperature feedback. This helps ensure the optimal temperature is reached to destroy the nail fungus without damaging normal tissue.
What are the advantages of laser?
Laser nail treatment is less invasive than surgical nail removal, more effective than topical lacquer and doesn’t have the risk of liver damage and adverse gut effects of oral medications. Laser nail treatment is quick and can be done in the rooms and is considered safe with FDA approval. Clearance rates are reported to be as high as 80-90%.
What does treatment involve?
It is important all nail polish is removed the day before treatment. A treatment session takes approximately 20 minutes to treat 5-10 nails. Most patients find the treatment quite comfortable and describe a warm sensation with sometimes a small hot pinch. Patients can resume normal activities immediately after treatment.
How many treatments?
The number of treatments will vary depending on how severely each nail is infected. Typically 3 treatments are necessary spaced about one month apart and then a follow up treatment after 6 months. Due to the slow rate of nail growth improvement in nail appearance will take a number of weeks to be noticeable. Most patients see results within 8-10 weeks.
Will the infection come back?
In cases of stubborn infection some patients will require further follow up treatments. There is no guarantee nail fungus will not come back because fungus is present everywhere in the environment. Clinical studies report about 80% of all patients have sustained improvement 12 months after laser nail treatment.