Can Lasers Be Used to Treat Toenail Fungus?

Onychomycosis, better known as toenail fungus, is an ongoing problem for a significant part of the population. This fungal infection can come from several sources which are very common in many environments and if left untreated, can eventually become very unpleasant and even dangerous. Estimates have shown that only around 20% of the people that suffer from a toenail fungal infection have actually been diagnosed by a podiatrist or other medical professional. Moreover, out of those diagnosed only around half have actually undergone treatment in order to eliminate this problem.

There can be a number of possible reasons for this. Some people do not see toenail fungus as a big deal. Others tend to ignore it until it starts to discolor or when it becomes painful. And some people simply cannot afford the medication. There are several treatment options but most of them are expensive and will require a long period of treatment before they are effective. However, with the continued progress of technology come new medical innovations and new techniques which are supposed to be superior to the ones we had before. This is apparently true for the treatment of onychomycosis, as well, which now benefits from a new method which uses lasers to kill the infection. However, there is still disagreement among medical professionals regarding whether this new technique is effective or not since the evidence to back it up has not been fully substantiated.

The Early Stages

Toenail fungus treatments using lasers have been practiced as early as 2009. One pharmaceutical company called Nomir Medical Technologies based in Waltham, Massachusetts began adapting a laser named Noveon in order to be used for nail treatments. This technology had already been in use for a long time in dental work, cataract surgery and even hair removal. The laser uses two different light wavelengths which can target and kill the fungi in the nails.

Only a small study has been made regarding the positive effects of Noveon. However, it showed that half of the 39 toenails which were exposed to the Noveon laser were free of infection just after four sessions (Singer). Out of those test subjects, 76% were growing regular toenails 6 months after the initial experiment.

With these encouraging results a number of podiatrists started using this method in order to treat their patients. In theory, there was no need for FDA approval thanks to a loophole which allowed doctors and other medical professionals to use products and technologies which were approved by the FDA previously for purposes others than the ones that they were originally intended for.

Skepticism Regarding Noveon

Thanks in part to the curious legality of using Noveon in order to treat toenail fungus infections as well as the limited research surrounding it there has been some criticism regarding its efficiency. At the moment, the number one treatment option for this kind of problem is Lamisil, a pill which is taken orally. This medication has been verified and approve by the FDA as being efficient at treating infection in 2 out of 3 people. This efficiency rating is bigger than the one obtained by Noveon in its small study so, in theory, it should have never been in doubt which one is the better method of treating this kind of infection. However, the selling point used by those that developed this technology as well as the podiatrists that use it is the lack of side effects which cannot be said about Lamisil. Use of this medication can come with headaches, rashes, diarrhea and in some cases it has even been linked to liver problems. In the meantime, the use of laser technology is advertised as being painless and safe which has attracted the attention of a lot of medical professionals.

In order to clear some of the confusion and controversy regarding the validity of laser technology in nail fungal treatment there has been one official study done focusing on the results and side effects of Noveon which was then published in the Journals of the American Pediatric Medical Association.

Their study took place over the course of 180 days where treatment using the laser was administered under strict supervision and following a tight protocol on days 1, 14, 42 and 120 (Landsman et al.). Each toe used in the study was evaluated, measured and photographed at different intervals throughout the 180 days. 26 toes were found to be suffering from onychomycosis: 10 of those cases were mild, 7 were moderate and 9 were severe.

After the 180 day treatment, an expert panel which was blinded in regards to which were the control and which were the treatment group evaluated the results and established that 85% of all the infected toenails saw some form of improvement and growth. At the end of the study, the researchers concluded that laser technology is a viable form of treatment for onychomycosis.

This study was seen as a significant strike for those advocating using Noveon technology to treat toenail fungus, but there were a lot of medical professionals that were still unconvinced. There are still some issues which have not been resolved. First is the price. This form of treatment is much more expensive than any other alternative. It usually costs around $1000, although in some cases the price went as high as $1500. Not only that, but at the moment it is not covered by any form of insurance. Lastly, there is still no work regarding the relapse rate. That is the only professional study done regarding this issue and there was no focus placed on relapse rate so there currently is no official number or even an estimate. Lamisil has a relapse rate of around 15% so it would need to be similar in order to be a viable treatment.

New Technologies

Since laser technology started gaining popularity there have been other companies which have been working on their own treatments. At this moment, the best is a company called PinPointe which has developed its own laser. There is one advantage to using this new technology and that is the fact that it is FDA-approved. In the study submitted and approved by the US Food and Drug Administration this laser technology has shown improvements in 70% to 80% of all patients after just a single 30 minute treatment. 81% of them had sustained growth after 12 months.

These results seemed very promising and they have renewed faith in laser technology as a viable treatment in the future. Since then there has been another laser cleared by the FDA called GenesisPlus. There is no clear benefit to using one or the other. Each treatment comes with the steep price of around $1000 and there still is no clear indication regarding how effective this method is at preventing any further infections after a longer period of time. It will take a few more years until there is a definite consensus regarding the efficiency of this new method and, until then, people who can afford to undergo laser treatment only have a financial loss to fear as there are no negative side effects towards using any of the lasers available.

Works Cited
Adam S. Landsman, DPM, PhD , Alan H. Robbins, MD , Paula F. Angelini, DPM , Catherine C. Wu, DPM , Jeremy Cook, DPM , Mary Oster, BS and Eric S. Bornstein, DMD. “Treatment of Mild, Moderate, and Severe Onychomycosis Using 870- and 930-nm Light Exposure”. Journal of the American Podiatric Medical Association Volume 100 Number 3 166-177 2010.
MarylandPodiatrist.net. Web. 10 Jul. 2012.
Singer, Natasha. “False Start on a Laser Remedy for Fungus”. NYTimes.com. 19 Mar. 2009. Web. 10 Jul. 2012.

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