Treating Onychomycosis With Laser Light

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Onychomycosis is a fungal infection usually caused by a special type of fungus known as a dermatophyte. These sorts of fungi are generally confined to the dead, horny outer layers of the skin and gradually progress to involve the nail plate. Onychomycosis is particularly common in toenails of older men but can affect of the nails of individuals of any age and sex. The treatment of this condition is complicated by the fact that these fungi live in dead tissue, and getting medications to these sites is problematic.

Since most of these infections are relatively superficial, it would seem that topical treatments ought to work well. This is not the case because the nail unit is relatively impenetrable. In addition, it is common for these infections to be entirely asymptomatic (not producing symptoms) which doesn't seem to diminish the patient's distress with the unpleasant appearance of the nail. A perfect treatment modality would be inexpensive, very effective, and very safe. Sadly, we have not achieved this perfect situation yet.

Currently accepted treatments include relatively ineffective topical therapies and oral treatments which are reasonably effective but are associated with some degree of risk. Both approaches require a long duration of treatment and are somewhat costly. Most experts agree that surgical approaches like removing the nail plate are ineffective.

It is into this environment that the use of lasers has been thrust. Of course, lasers are a very sexy, modern, technologically advanced approach to the treatment of a variety of human diseases. Lasers produce coherent light energy of a sufficient strength and of a specific wavelength which when projected into tissue is differentially absorbed by the target material, producing heat and hence tissue destruction. Other tissue components are unaffected and so spared. Medical lasers are rather expensive devices, so treatments with these machines requires generally quite high fees to recoup the original purchase price of the equipment.

Do lasers work better than the medical approaches for the treatment and cure of onychomycosis?

Since laser treatment is very new, the data to answer this question are just not available yet, while there is substantial evidence to support for the efficacy of medical therapy. Most avid commercial radio station listeners can testify to the prevalence of advertisements touting laser therapy. In a survey of the journal articles cited in PubMed on laser treatment for onychomycosis, there were only two dozen citations (in the last 10 years) on the subject, only three of which reported on groups of patients documenting clinical efficacy. One recently published article documents a small uncontrolled study of the safety and efficacy of the use of a Nd:YAG 1094 nm laser in the treatment of nine patients. Each involved nail was treated with multiple laser exposures one to three times over a four- to eight-week period. The results of this small study indicate that this may be a potentially useful and safe modality. A second study on eight patients using a similar laser was similarly uncontrolled but did produce optimistic results. In a third study, an entirely different sort of laser (infrared) was used to treat 26 toes on an unknown number of patients. Results again appeared promising.

A critical interpretation of these studies indicates that laser treatment of onychomycosis is not quite ready for prime time. It is probably reasonably safe, but its efficacy remains to be proven especially when compared to other accepted treatment modalities. As far as cost is concerned, it is unlikely that laser treatment would be less expensive than current medical therapy.

REFERENCES:

Hochman, Lisa G. "Laser treatment of onychomycosis using a novel 0.65-millisecond pulsed Nd:YAG 1064-nm laser." Journal of Cosmetic and Laser Therapy 13.1 Feb. 2011: 2-5.

Journal of Drugs in Dermatology 11 (2012): 497-504.


Last Editorial Review: 6/7/2012 6:00:28 PM



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