Debridement / surgical nail removal by itself is fraught with high recurrence rates. Recurrence is less common when combined with topical anti-fungal medication/s throughout the nail regrowth period. Surgery involves discomfort and recuperation.
Fungal nail laser therapy is effective (up to 90% efficacy) and FDA-approved. Quasi-long pulsed 1064 infra-red wavelength lasers appear most effective. Short pulsed q-switched 1064 lasers may also be effective. The mode of action may involve direct phototoxic and/or heat-derived fungal destruction.
What is Onychomycosis / Tinea Unguium?
Onychomycosis or Tinea Unguium is the medical term for fungal infection of the nail. Onychomycosis is associated with discoloration and/or abnormal characteristics of the nail with or without symptoms.
Onychomycosis is common, infecting around 2-3% of the population. Uncommon in children, incidence increases with age, afflicting 15% for those between the ages of 40 and 60.
Onychomycosis is responsible for over half of all nail disorders; and is the most common adult nail disease. Toenails are much more likely infected than fingernails.
Onychomycosis infection is acquired by invasion of the nail plate from adjacent infected skin or directly through the surface of the nail plate by pathogenic fungal species, specifically acquired from direct contact with an infected source. Such species are ubiquitous in our environment. Age, diabetes, peripheral vascular disease, HIV infection, and other immune modulating disease or medications are predisposing factors.
Initially, onychomycosis is usually asymptomatic (without symptoms); hence, most patients seek treatment for cosmetic reasons. However, long-standing/advanced infection may cause numbness, discomfort, tenderness or pain, which can result in difficulty standing, walking or exercising. Fungal nail infections may be a risk factor for bacterial cellulitis, a more dangerous skin and subcutaneous infection. Patients with onychomycosis may also report decreased self-esteem and / or social interaction.
Treatment Options for Onychomycosis
Treatment options for onychomycosis include:
- topical and/or oral anti-fungal medications,
- debridement/surgery (nail removal)
- laser therapy
Topical agents require diligent, long-term use and are the least effective solo treatment.
Oral anti-fungals offer better cure rates, but rarely may cause toxic liver hepatitis and thus, are not usually recommended for asymptomatic disease.
Our current laser treatment protocol is to treat all nails of the affected extremity monthly for 3 or more consecutive months and re-evaluate at 3 months post treatment. Because fungal nail disease is so difficult to cure, prone to recurrence and combination therapy increases success, we also advise concurrent use of topical anti-fungal medications.
Fungal nail laser therapy is quick, safe, effective, and typically painless. All motivated patients with onychomycosis are candidates. Insurance does not cover fungal laser treatments.
Download our Toenail Fungus Laser Treatment Brochure for more info.
Contact us at info@strimderm.com or call us at (702) 243-6400 to schedule a laser fungal nail consultation.