Laser Ushers in a New Era of Treating Nail Fungus

Traditional Treatment Methods Slowly but Surely Falling Out of Favor

Nail Fungus (Onychomycosis) is a problem that affects an estimated 35 million Americans and has long caused both physical and emotional distress to those afflicted. Traditionally, physicians have acknowledged the challenge of eliminating the fungus due to its hardy nature and its embedded and difficult-to-reach location underneath the nail. Topical applications have had limited success and are viewed as nothing more than a containment approach. In other words, the topical application won’t necessarily “cure” the nail fungus, but it should prevent worsening or spreading. Oral medications such as Lamisil do work for people in an estimated 50% of cases and possibly slightly higher, but any success comes with significant and potentially serious side effects often requiring constant blood testing to monitor for potentially serious complications. Given these considerations, many patients simply won’t bother.

Laser Technology Offers Something New, Something Better fro Treating Nail Fungus

Within the past few years, lasers are being increasingly used for treating onychomycosis. The wavelengths available for treating nail fungus are:

  • 870 nm
  • 930 nm
  • 1064 Nd:YAG Long Pulse
  • 1064 Nd:YAG Q-Switched

Some of the device product names that physicians may be familiar with include the PinPointe Foot Laser, CoolTouch Varia Breeze, Noveon Laser, Cutera Genesis Plus, and the K Laser just to name a few devices that claim they can be used for treating nail fungus. What all of these devices have in common is their need for multiple treatments to eradicate nail fungus. Further, they each attempt to create a fatal temperature end point to destroy the fungus, believe to be in excess of 50 degrees Celsius. The net effect of these lasers is to heat the water content in the nail bed in an effort to similarly terminate the fungal spores residing under the nail itself.

Clinical results from the above devices suggest that in a best case scenario, improvement of significant to total new clear nail can be expected in perhaps 70% of cases, again, after multiple sessions. However, the fall of 2011 marked the first Q-Switched Nd:YAG device to be specifically FDA approved for onychomycosis. That device – the Q-Clear™ Laser – appears poised to blow the roof off of all previous forms of nail fungus treatments.

How the Q-Clear™ Laser System Is Different from Other Devices

There exist at least three mechanisms of action to support why the Q-Clear™ Laser works so effectively at destroying nail fungus in a single treatment.

    1. Thermal. Adding sufficient heat to the nail and/or nail bed raises the local temperature enough to kill or inhibit the fungus. Many devices target the water content in the nail bed as a bulk heating mechanism. The Q-Clear™ instead targets the fungus, not the nail bed.

    2. Selective Photothermolysis (SP).
    According to the principle of SP, selection of the proper pulse width will keep the energy confined to the target, causing a temperature rise in the target without raising the temperature in the surrounding tissue. The thermal relaxation time of fungal elements is in the 100-500 microsecond range, therefore this pulse width will cause a lethal temperature rise in fungal elements (targeting) with minimal temperature rise in the surrounding nail bed (“anti-targeting”).

    3. Photomechanical. According to the theory of SP, nanosecond domain pulses should target organelles and other submicron sub-cellular elements. Rapid energy absorption leads to expansion and collapse with cavitation and mechanical disruption. Furthermore, the low water content and concomitant low thermal diffusivity of fungal elements (versus the high water content and much higher thermal diffusivity of the nail bed) allows a much greater temperature rise when a train of nanosecond pulses is delivered over the course of microseconds.

Most devices emit pulses in the microsecond domain, thus heating the nail bed. This can not only cause sufficient discomfort to the patient, but if the fungus in NOT destroyed, the process of heating the nail bed can actually cause the presence of fungus to WORSEN. The passively q-switched Q-Clear™ Laser emits a train of nanosecond pulses within an envelope corresponding to the thermal relaxation time of fungal element and is dramatically effective without pain or significant increase in nail temperature. This effect causes a temperature rise in the fungal elements and their spores, which can’t shed heat because of their low water content and low thermal diffusivity, while the high water content of the nail bed allows any heat to be easily shed preventing a significant or painful increase in temperature. Unlike other devices, the Q-Clear’s nanosecond pulses selectively heat the fungus versus the nail bed which appears to be the technological key to its immense success in treating this affliction.

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