By: Dr. Falls
Onychomycosis of the toenail is a chronic infection of the nail plate and nail bed by dermatophytes, yeasts, and opportunistic fungi. It is believed that over 35 million American’s alone suffer from this disease. It is found to be much more prevalent in Southern states due to environmental factors and comorbidity disease states. Until recently treatments were limited to topical OTC and prescription nail liquids and oral anti-fungal therapies. Topical therapies both OTC and prescription such as topical ciclopirox have few side effects however they require sustained use by the patient for 6-9 months for toenail therapy. Unfortunately the cure rate is below 50% in most all studies even with correct sustained application. Oral anti-fungal therapies such as itraconazole and terbinafine have a much higher mycological cure rate approaching 80-90% in most studies however there are hepatic function contraindications for many patients.
With so much of the population affected by this disease there have been many attempts to find better therapies both with regard to reduced contraindications as well as providing higher cure rates. Recently, the emergence of new technology has brought about another option for the treatment of onychomycosis. Laser treatment to the toenail is now a better option for almost all patients regardless of age or other medical conditions. Utilizing very specific wavelengths, the newer lasers are able to cause photo damage and/or ablation of the fungus within the toenail. This new therapy is now available at Alabama Foot Institute on Montclair Road. In the office setting the patient’s nails are treated utilizing specific wavelengths of laser light without the need for local anesthesia. There is very limited thermal effect and the treatment of 10 toenails takes only 10-15 minutes. As the nail plate grows normally it will grow proximally increasingly clear. It takes 4-9 months typically for full toenail growth and full clearing. In most cases no further laser treatments are needed. This therapy option is excellent for those patients who either cannot or do not wish to take oral therapy.
Todd Falls, DPM
Alabama Foot Institute