Laser Treatment for Toenail Fungus

Laser therapy is a treatment for toenail fungus infection (onychomycosis). Fungal infections of the nails usually require several laser treatment sessions before they get better. It may take three to 18 months of consistent treatment for laser therapy to be effective for toenail fungus.

Laser treatments for toenail fungus are considered safe but can cause side effects such as pain and/or bleeding of the area around the nail. Laser therapy is approved by the U.S. Food and Drug Administration (FDA) to treat toenail fungus.

This article will cover what you should know about using laser treatments for toenail fungus.

Benefits

Several types of laser devices have been cleared by the FDA to treat toenail fungus, including PinPointe Footlaser, GenesisPlus, and Noveon. According to the FDA's criteria for approval, these devices may produce a "temporary increase in clear nails in patients with onychomycosis."

With laser therapy, most people see noticeable improvement and there is a high cure rate. One study showed a 61% cure rate at 16 weeks. Another study showed 91% clinical improvement and a 30% cure rate at 180 days.

Laser treatment is associated with high rates of negative cultures. That means a laboratory test for a fungal infection does not show evidence of infection after treatment.

How Laser Treatments Work for Toenail Fungus

There are several types of laser treatments that can be used to treat toenail fungus, including some that use light and others that use carbon dioxide (CO2).

Laser devices emit pulses of energy that produce heat. When used to treat onychomycosis, the laser is directed so the heat will penetrate the toenail to the nail bed where the fungus is.

For this type of treatment, CO2 lasers or yttrium-aluminum-garnet (YAG) lasers with wavelengths of 870 nm, 930 nm, or 1320 nm are used.

In response to the heat, the infected tissue turns into a gas and breaks down, destroying the fungus as well as the surrounding skin and nails. The heat from the lasers also has a sterilizing effect, which helps prevent new fungal growth.

When used safely, laser treatment does not emit enough energy to destroy all the tissue or all of the infection. Therefore, repeat treatments are usually needed. According to a study of 56 people with onychomycosis, an average of four treatment sessions were needed to eliminate the nail fungus.

The fungal growth is inhibited and some of the fungal microorganisms are destroyed, but since the infection can partially survive the treatment, it's unlikely that you will be completely cured of toenail fungus with just one session of laser therapy.

Who Performs Laser Toenail Treatments for Toenail Fungus

Laser toenail treatments for toenail fungus are performed by a cosmetic dermatologist. Because the treatment is considered a cosmetic procedure, you will need to find a dermatologist who performs cosmetic treatments (e.g., chemical peels, tattoo removal, botox injections).

When searching for a cosmetic dermatologist, look for the following:

• Board certification: A board-certified dermatologist is trained and qualified to treat skin conditions.
• Special certification: Look for a dermatologist who has specialized training and experience with laser toenail fungus treatment. You should see "laser nail fungus treatment" or something similar listed clearly on the provider's website.
• Testimonials: Scan through a provider's reviews and testimonials to get a sense of what to expect when you visit their office. Look for reviews about hygiene, cleanliness, and patient satisfaction, and scan for other reviews related to laser treatments.
• Consultations: Cosmetic dermatologists should always offer a free or low-cost consultation before approving you for treatment. The consultation allows them to check your skin thoroughly and make sure laser treatment is right for your case.
  

If you are still not sure how to find a board-certified cosmetic dermatologist, consult with a healthcare provider for recommendations.

Safety

Laser treatment for toenail fungus has an excellent safety record. Unlike traditional nail fungus treatments, such as oral or topical antifungal medications, lasers are not known to cause adverse drug interactions, reactions, or allergic responses.

Laser treatment for toenail fungus is also considered to be a safe alternative for people who have kidney or liver disease, diabetes, or who do not tolerate drugs well.

Risks and Side Effects

Possible side effects of laser toenail fungus treatment include:

• A mild to moderate but tolerable burning sensation during treatment
• Bleeding, which happens infrequently and is reduced by lowering laser intensity

When laser treatment is done properly by a trained and certified dermatologist, it is highly unlikely to damage the nail or surrounding skin.

However, if treatment is done with too much intensity, the laser may penetrate the nail and wound the nail bed. This can potentially lead to the formation of an eschar under the nail, a type of scab-like sore comprised of dry, dead tissue. It may be red to brown and tender, and may easily bleed.

Receiving treatment from a qualified and experienced provider greatly reduces this risk.

Alternative Treatments

Laser treatments are typically more effective than other treatments for nail fungus.

A nail fungus infection can sometimes be treated with topical (on the skin) antifungal medications or oral antifungals. There are also over-the-counter (OTC) and prescription options.

Antifungals taken by mouth (oral) can cause full-body (systemic) side effects and do not necessarily cure toenail fungus. Topical treatments are generally considered safe but may not be effective.

Research has shown there is approximately a 45% improvement in toenail fungus with topical medicine and approximately 40% to 66% improvement with oral medication.

However, there seems to be a range in terms of how well these different treatments work. Using them consistently while avoiding side effects can be difficult. Combining treatments might be more effective than using a single treatment.

What to Expect

Laser treatment for toenail fungus can typically be completed within one or two sessions. The laser procedure itself is quick and simple, typically taking about 30 minutes to complete.

Prepping for Laser Treatment

At your first consultation for laser treatment of nail fungus, your provider will ask you about your symptoms. Typically, onychomycosis is diagnosed based on how the nail looks but they might want to take a sample to look at under a microscope.

Your treatment will be administered by a dermatologist. You might also have a procedure to have your toenails clipped and dead skin cleaned (debridement) on the day of your laser treatment or a few days before.

Right before your procedure, your foot will be cleaned with a sterile solution and put in an accessible position so the provider can direct the laser.

During the Procedure

Anesthesia is not needed for laser toenail fungus treatment. Once your nail is prepped, the dermatologist will pulse the laser using selected wavelengths. This helps minimize heat on the skin and reduces the risk of side effects.

As the tissue breaks down, you may have some pain and/or bleeding. If the pain is too much for your tolerance, let your dermatologist know so that they can adjust the laser's settings.

Recovery

Once the procedure is finished, the dermatologist will tell you how to keep your toe clean and dry as it is healing. The provider may give you a topical antifungal cream, such as tioconazole, to apply to the nail. Make sure you follow the provider's directions carefully.

The skin will heal in a few days. Any additional treatment sessions are typically spaced two to six weeks apart.

Even effective treatments are not expected to clear an infected nail immediately—it may take up to 18 months until the nail grows out for you to tell whether the treatment has been successful.

Signs of improvement in toenail fungus after laser therapy include:

• The disappearance of yellow, white, or brown discoloration of the affected toenail or toenails
• Resolution of flaky debris under or on the nail
• Recovery of nail detachment from the nail bed below (onycholysis)
• Normal shape and texture of new nail growth with no more thickness, bumps, or altered nail shape
  

Does Insurance Cover Toenail Laser Treatment?

Laser toenail fungus treatment is considered an elective, cosmetic procedure. Unfortunately, cosmetic procedures are not covered by health insurance. The cost of treatment depends on the severity of the infection, how many nails are affected, and the number of sessions needed. In general, expect to pay between $100 and $400 per treatment session.

Summary

Several types of laser therapy can treat toenail fungus. Laser treatment has a low risk of side effects, but you may feel some burning or pain during the treatment. After the procedure, you will need to wait for your nails to grow out before you see an improvement. It may take multiple treatment sessions to remove the nail fungus completely.

Laser toenail fungus treatment should be done by a board-certified dermatologist who is experienced in the procedure. There are also other treatments you can try for toenail fungus, like OTC and prescription topical and oral medications, but they may take longer than laser treatment and are often less effective.