Treat fungal nails without pin or pills

John Ringer from Laser Nail Clinic - Rodney

This is an extract from a review of treating fungal nails that you may find interesting...
Table 2: Most common predisposing factors for onychomycosis [5,14].
Impaired Quality of Life and Stigmatisation due to Onychomycosis
Studies have found that generally patients with onychomycosis avoid social gatherings as they have a fear of transmitting the infection to other people [5,11,12].
When patients were asked how they feel about the stigma onychomycosis has caused, patients felt greatest impairment due to onychomycosis being contagious; felt other people would stare at their nails and felt unattractive [5,12]. The most common problems affecting patient quality of life is cutting nails; disfigurement (cosmetically); illfitting shoes, leading to pain and discomfort [5,12].

In Vivo Studies
Horine et al. yielded retrospective results from an international multicentre study of 262 patients. Patients received one PinPointe short-pulsed Nd: YAG 1064 nm laser treatment. A single spot consisted of a pulse train of ten 200 mJ, 90 μs duration pulses at 1064 nm, delivered into a 1.5 mm spot. Laser was delivered in a 1.0-1.5 mm spacing grid pattern. The average light dose per nail plate was 115 J/ cm2. One or two laser passes was delivered per infected nail. Pretreatment debridement and thinning of onycholytic hyperkeratotic nail plate to 1 mm was achieved using a high-speed burr. Photographs were taken of the hallux at baseline and at post-procedure follow-up. A 100% response rate was seen with a mean of 78% absolute clear nail was achieved at seven month post-procedure follow-up [25].
Becker and Bershow reviewed three studies which achieved clinical success using a 1064 nm Nd: YAG laser. One study 72 patients received four laser treatments with one week between sessions. Three months post-treatment, 95.8% were clinically clear and culture negative. No details on culture sampling or laser parameters was given. All patients were followed up 6, 9 and 12 months post-procedure for recurrence and at the end of the study all patients were clinically and culture negative. In the second study eight patients were treated every three weeks for three sessions with a 1064 nm pulsed Nd: YAG laser. Seven out of eight patients were culture negative after the third treatment. No significant side effects were reported. These patients were also prescribed a topical nail lacquer after the first laser treatment. A third study conducted by Kimura et al. irradiated 37 toenails with microscopically confirmed onychomycosis up to three times with a 1064 nm Nd: YAG laser. At 16 weeks post-procedure follow-up 81% of toenails exhibited moderate to complete clearance [2,24].In 2014, Birstow did a systematic review of the effectiveness of lasers in the treatment of onychomycosis. Any original study, published in a peer reviewed journal, which examined the use of a laser technology in the treatment of onychomycosis was considered for inclusion. The initial search yielded 268 potential papers. Subsequently, duplicate papers, papers that did not fit the inclusion criteria and papers whose full study details were not obtainable were excluded from the review.
The remaining 12 papers that were published in the last four years were included in the review. He concluded that to date the data reported was at a low level of evidence as it was made up predominantly of case series involving a small number of patients with only two small randomised controlled studies (Table 4) [14].
AUTHORS LASER PATIENTS/NAILS TREATMENT DURATION OUTCOMES
Horineet al. PinPointe short-pulsed 1064 nm Nd: YAG 262 patients One treatment per infected nail 100% response rate; mean of 78% absolute clear nail at 7/12 follow up
Becker and Bershow 1064 nm Nd: YAG 72 patients Four treatments; one week between sessions 95, 8% clinically clear and culture negative at 3/12 follow up
1064 nm Nd: YAG 8 patients Every three weeks for three sessions (3; 6; 9) Seven out of eight patients culture negative after third treatment
Note: Topical antifungal prescribed after first treatment
1064 nm Nd: YAG 37 toenails Up to three treatments 16 weeks follow up 81% exhibited moderate to complete clearance

You can see the whole review here:-
www.omicsonline.org...