New laser therapy for the treatment of onychomycosis

Onychomycosis, commonly known as nail fungus, is a persistent fungal infection of the nail that causes a change in the color, shape and thickness of the nail, and even destroys it completely if not handled correctly. Onychomycosis is particularly common in the toenails of older people; it is proven that 50% of individuals over seventy suffer from this condition, although it can appear at any age. Until now, the therapeutic options for the treatment of onychomycosis have included palliative care, mechanical or chemical debridement, topical and systemic antifungal agents and different combinations of these modalities. All of them have presented a high failure rate. Today, thanks to advances in medical technology, there is a new fast and effective method: laser treatment, which treats quickly, safely and without the side effects associated with systemic medication.

How does it work? The laser radiation penetrates through the surface of the nail and reaches the nail bed, which is where the pathogens are located. This wavelength inactivates the deeper fungal pathogens through light, without affecting the surrounding skin tissue. As a result, the increase in temperature injures the cell wall of the fungus, causing it to die and stimulating the repair process. The treatment is simple and fast, with no side effects or appreciable complications. Onychomycosis therapy with a 1064nm laser causes a controlled thermal effect on the tissue, which eliminates mycotic infections in a comfortable, safe and effective way. In clinical studies, an improvement has been observed in 68% of patients after three treatment sessions, although there is no total guarantee of success. The results depend on the minimization of the risk of recurrence through the appropriate hygienic precautions (disinfection of footwear, washing of socks at 60 ºC....).

Treatment procedure The first step consists in the fact that the podiatrist, in order to confirm the clinical diagnosis, collects a sample of the affected nail area and carries out a culture in a microbiological laboratory in order to make a differential diagnosis of the various nail diseases that are they can confuse with onychomycosis, including psoriasis, atopic dermatitis and lichen planus. Thicker nails should be pre-treated by a good milling of the nail to ensure better penetration of the laser light. The treatment is carried out using a 1064nm laser light, continuous and 10W power with 10ms pulse trains. The laser light is applied to the nail plate in its entirety, constantly moving the light beam in a spiral shape over the affected nails. The crucial factor in the success of the laser treatment is the heating of the nail bed to approximately 45 ºC and the maintenance of the heat for at least forty seconds. Depending on the size of the nail, the laser treatment usually lasts from one to three minutes per nail, that is to say about twenty minutes to treat all the nails. The full course of treatment usually consists of four sessions with an interval of three weeks between sessions. The procedure is comfortable, painless and without any side effects; some patients may notice a slight feeling of warmth in the nail.

results The growth of the new clear nail structures is not immediately visible, although approximately six to eight weeks after the initial treatment the new clear nails begin to be noticeable. If this is not the case, additional treatment may be applied if the fungal infection is very severe. The final result should become visible between nine months and a year. This method is useful for a wide range of patients and is particularly beneficial in elderly, compromised and liver-impaired patients, in whom other alternative treatments might present some risks. Lasers are playing a key role in the treatment of onychomycosis, with cure rates superior to terbinafine in most cases.

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