Magazine for the professional nail industry.
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HEALTH} Treating Fungus With Lasers For years, treatment of fungal nails has been frustrating and only nominally successful. At last, evidence of safe, eff ective treatment provides hope. BY MICHELLE PRATT In the past, treatment for nail fungus was limited to home remedies and a prayer, topical treatments and some hope, or an oral prescription with a doctor's oversight. Doctors needed to monitor patients because the medicine was known to cause liver damage. Today another option exists: laser treatment. "The laser creates a thermal effect," explains Steve Duddy, president and CEO of NuvoLase, Inc., the manu- facturers of PinPointe FootLaser. "Temperatures are raised to levels high enough to impact the growth of the fungus without causing discomfort to the patient," says Duddy. The PinPointe FootLaser lauds itself as the "⇒ rst light-based device to receive FDA clearance speci⇒ c to the treatment of onychomycosis" and, reportedly, over 100,000 patients have been treated with PinPointe FootLaser worldwide. The FDA restricts laser companies from making a claim of curing a fungal infection. Instead, speci⇒ c wording must be used to offset any promises. "All lasers today with a clearance speci⇒ cally for treating onychomy- cosis have the same label, and it is as follows: 'The PinPointe FootLaser is indicated for use for the temporary increase of clear nail in patients with onychomycosis (e.g dermatophytes Trichophyton rubrum and T. mentag- rophytes, and/or yeasts Candida albi- cans, etc.),'" says Duddy. The "tempo- rary increase of clear nail" is the only claim the FDA supports currently. Word games aside, laser treatment has an impressive performance record. PinPointe FootLaser boasts a 71% sustained improvement rate among clients, but individual doctors note rates can be even higher. "With more aggressive debridement before treatment, along with post- treatment environmental controls, as well as follow- up topical preparations to the skin and nails of the feet, success rates can be as high as 88%-92%," says George Trachtenberg, D.P.M., who runs a practice in Vestal, N.Y. Observe the nails before treatment with the PinPointe FootLaser and four months after treatment. 112 | NAILS MAGAZINE | DECEMBER 2012 The severity of the fungal infection is one factor that determines success. "With mild- moderate cases, patients have an excel- lent chance of success," says Michael Bilinsky, D.P.M. and podiatric laser specialist near Beverly Hills, Calif. "With severe cases, clients have seen dramatic improvement, but when they expect to end up with a normal nail, they can be disappointed." Dr. Bilinsky warns his patients that laser treatment offers absolutely no guarantee, so he prefers to under-promise and over- deliver. Success rates are affected not only by the severity of the infection, but also by a number of extenuating factors, including genetics, age, a patient's health, footwear, hygiene, and more. Doctors prescribe a post-treat- ment plan, and success often hinges on how closely patients follow it. Laser treatment is not covered by insurance as the condition is considered a cosmetic problem rather than a medical one. However, the cost isn't so overwhelming as to be prohibitive, and patients have the added advantage of being able to shop around for their doctor instead of being assigned to one by an insurance company. "No two lasers, no two doctors, no two patients are the same," says Dr. Bilinsky. "Some doctors will laser only the affected nails; some will laser all 10 nails since fungal material is lying on top of all the nails, even ones that appear unaffected." © USED BY PERMISSION DR. DANIEL WALDMAN, DPM, FACFAS