Laser Treatment for Toenail Fungus

How It Works

Toenail fungus (onychomycosis) is a common infection of the nail, and it may affect approximately 6.5% to 8.7% of the North American population. It affects adults, particularly the elderly (older than 60 years old), males, diabetics, immuno-compromised individuals (e.g., HIV-positive patients), smokers, and patients with psoriasis, as well as those with peripheral arterial disease (PAD), previous Athlete’s foot, history of trauma to the nail, or a family history of onychomycosis.

Toenail fungus is caused predominantly by anthropophilic dermatophytes, and less commonly by yeasts and non-dermatophyte molds. Dermatophytes are the most common pathogens of fungal toenails, accounting for 80% or more of the infections.

In spite of the clearly diseased appearance associated with this condition, onychomycosis is all too often regarded as merely a cosmetic problem of relatively minor importance that is hardly worth the effort to resolve. This belief may have been supported by the adverse effects and long dosing courses associated with some of the earlier antifungal agents.

Infected Toenails Before Treatment

In fact, onychomycosis can have significant negative effects on patients’ emotional, social, and occupational functioning and can; in addition, consume a sizable proportion of health care dollars. Affected patients may experience embarrassment in social and work situations, where they feel blighted or unclean, unwilling to allow their hands or feet to be seen. Patients may fear that they will transmit their infection to family members, friends, or coworkers, fears that can lead to diminished self-esteem and the avoidance of close relationships.

Organisms that cause onychomycosis can invade both the nail bed and the nail plate. Dermatophytoses of the fingernails and toenails, in contrast to those at other body sites, are particularly difficult to eradicate with drug treatment. This is the consequence of factors intrinsic to the nail—the hard, protective nail plate, sequestration of pathogens between the nail bed and plate, and slow growth of the nail—as well as of the relatively poor efficacy of the early pharmacologic agents.

The efficacy of current treatment options, including topical, oral, mechanical and chemical therapies or a combination of these modalities is low. Topical drug treatment for onychomycosis is not usually successful because the drugs are unable to penetrate the nail plate and rapid recurrence can occur after discontinuing use. Oral antifungal agents are more effective although more toxic with a significant risk of liver toxicity, prolonged loss of taste, and life threatening drug interactions. Fungal resistance can occur when the oral antifungal agents are used on a long-term basis. Topically applied antifungal drugs may work somewhat better adjunctive to surgical removal or chemical dissolution of the nail plate. Yet, this often ineffective and traumatic procedure leaves the subject without a nail for months at risk for re-infection.

The CoolTouch® CT3P CoolBreeze laser is an FDA cleared device and is indicated for use in dermatology for incision, excision, ablation and vaporization with hemostasis of soft tissue. The unique handpiece design of the CoolTouch® laser allows the operator to maintain a constant distance from the area to be treated resulting in constant and uniform energy delivery. The CT3P CoolBreeze laser has a unique thermal sensing mechanism designed to control the amount of energy delivered to the toenail by pre-setting the desired end target temperature. In addition, patient comfort is assured by a spray of a cooling agent when the target temperature is reached. In clinical trials, a positive response demonstrating a 79.6% increase in clear nail growth as compared to baseline photographs in the test group of laser treated toes. Patient satisfaction was between satisfied to very satisfied.

Infected Toenails After Treatment