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Laser treatment for nail fungus

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  #361  
Old 22nd February 2012, 02:51 AM
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Default Re: Laser treatment for nail fungus

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Press Release:
Aerolase® Launches New Laser Technology With The LightPod Forte™
Aerolase® - the company that has reinvented the medical laser - brings podiatrists everywhere breakthrough laser technology in treating nail fungus.
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The LightPod Forte™ is a 1064nm gold-standard laser for podiatry (Nd:YAG) with more than a 90% success rate in nail treatment. It emits energy in a gentle pulse lasting for a 0.65 millisecond on the foot or ankle, coagulating soft tissue including warts, fungal material, vascular formations, telangiectasias (spider veins), scars and even tattoos. The maintenance-free LightPod Forte passes its laser energy through the nail plate or the epidermis, delivering most of its heat into the targeted tissue for maximum results, diminishing or completely eliminating undesired tissue structures.

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Besides the satisfaction of successfully treating their patients, thanks to the versatile LightPod Forte™ laser, podiatrists can also generate new revenue streams for their practice. First, due to shorter nail treatment time compared to the lower power laser alternatives, podiatrists are able to see more patients per week, sometimes even possibly fitting them in between medical patients’ visits. Second, because it’s the only truly portable high power laser, the LightPod Forte™ can be used in multiple clinics and serve a much wider geographical market. Finally, let’s not forget word-of-mouth advertising and referrals. With a success rate this good that has even been published in peer-reviewed journals, it’s only a matter of time before the word spreads and business grows.

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  #362  
Old 27th February 2012, 11:02 AM
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Default Re: Laser treatment for nail fungus

Just heard a radio ad for a clinic in Dublin offering laser treatments for nails for €150!
Website advertises €300 but radio ad offers €150

Is this the cheapest laser treatment for mycotic nails available?

Would be worth flying in from the UK for a days treatment at these prices.

Akina Beauty and Laser Clinic


Justin
podiatry.ie
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  #363  
Old 27th February 2012, 11:42 AM
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Default Re: Laser treatment for nail fungus

My guess is that light-based fungal toenail treatment will become even more inexpensive as time goes on just due to the number of companies now marketing this therapy. The question is, how long will the nails stay looking better after any of these therapies without becoming reinfected?
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  #364  
Old 6th March 2012, 02:13 PM
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Default Re: Laser treatment for nail fungus

There are plenty of people who will pay to have their teeth whitened only to see them darken again, so I see a time when:-

The price of the laser treatment x the duration of cosmetic improvement = cost of paliative care. The laser will become the routine treatment for fungal nails.
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  #365  
Old 14th March 2012, 05:40 AM
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Default Re: Laser treatment for nail fungus

I thought I would post these again because I can and because so many people have an idea about dystrophy, mycosis, recovery and permanent damage which is somewhat inacurrate. FYI female pt, @62 om 10 yrs plus terbinafine (oral) intolerant, image one before PinPointe FootLaser therapy in Dec 2009, image two in January 2011. Please note the difference in mycosis and dystrophy. Personally I think the two images seem a little different.
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File Type: jpg CIMG3584.JPG (295.9 KB, 281 views)
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  #366  
Old 14th March 2012, 07:59 AM
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Default Re: Laser treatment for nail fungus

Thanks Hamish

Please could you post the dosage (exposure parameters) and frequency of treatment for this case

thanks

Martin

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1365 Grant Ave.
Winnipeg Manitoba R3M 1Z8
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  #367  
Old 14th March 2012, 01:23 PM
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Default Re: Laser treatment for nail fungus

Quote:
Originally Posted by hamish dow View Post
I thought I would post these again because I can and because so many people have an idea about dystrophy, mycosis, recovery and permanent damage which is somewhat inacurrate.....

Nice pics Hamish.

Would you mind elaborating on who these many people are and which inaccuracies they are postulating?

I don`t doubt that clinical cure is obtainable with the PinPointe FootLaser in some patients. But, I fail to see how this therapy can alter all of the multi-factoral conditions associated with OM and prevent the high recurrence rate of symptoms in susceptible individuals. Consideration of environmental, genetic, immune system (AMP`s) and a host of other variables, have to be taken into account for prevention of recurrence (as with all anti-fungal treatments), which is key to long term management, IMO.
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  #368  
Old 19th March 2012, 12:58 AM
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Default Re: Laser treatment for nail fungus

FDA approval of laser therapy for onychomycosis does not equate to proven efficacy
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  #369  
Old 20th March 2012, 08:10 AM
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Default Re: Laser treatment for nail fungus

Mart:
Lased on 2 occassions.
2nd lasing was done at patients request @ 10 months or so after 1st lase. Toe was looking pretty much as it is now, but patient who had had it for a decade wanted "to be sure".
Dosage was a dot matrix pattern extending from mid distance between eponychium and IPJ to hyponycium area and laterally to @2mm beyond the sulci. This is now over 2 years since primary lase.

BLinda:
Conventional wisdom often cited that om "might" be treated, but nail dystrophy is permanent, my experience is different. Other than that it is a significant & potent, non pharmaceutical treatment option for om and bacteria, and has some interesting cosmetic interactions too. Not sure if it is said anywhere that it does the other stuff that you fail to see. It is a tool, needs to be understood and operated well to obtain best results, like most things.
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  #370  
Old 20th March 2012, 10:28 AM
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Default Re: Laser treatment for nail fungus

Quote:
Originally Posted by hamish dow View Post

BLinda:
Conventional wisdom often cited that om "might" be treated, but nail dystrophy is permanent, my experience is different. Other than that it is a significant & potent, non pharmaceutical treatment option for om and bacteria, and has some interesting cosmetic interactions too. Not sure if it is said anywhere that it does the other stuff that you fail to see. It is a tool, needs to be understood and operated well to obtain best results, like most things.
Hi Hamish,

Thanks for the reply. I guess it depends on the original cause of dystrophy, eh? I do refer pts who are interested in this method of treatment to a private skin clinic here in Winchester for treatment with the PinPointe and have observed impressive results. However, I still believe that other factors, a swell as clinical cure, should be addressed and realistic long term outcomes/recurrence rates explained to pts who are prone to OM.

Cheers,
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  #371  
Old 20th March 2012, 04:34 PM
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Default Re: Laser treatment for nail fungus

One always hope Blinda that one gives an encompassing consultation before one embarks on any form of treatment. We do our best to talk across all options and the client can go away and make an informed decision. What has been very interesting for me is seeing the effects of therapeutic interaction that have not really been witnessed before. Some of the idle speculaton I read from time to time really does not seem to marry up with what is presented to me in the reality of the laser treatments. What has been beneficial to me is the reaction of a number of my patients who have been doing their research and have visited these pages (it being open access to the public) is their horror at reading the tone and content of some postings. There has been real shock expressed, by other professionals upon their reading of the posts. I suppose some people don't know the public look here.
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  #372  
Old 26th March 2012, 07:32 PM
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Default Re: Laser treatment for nail fungus

Colleagues:

It is with great pride that I can announce the publication of 270 day data from our pivotal onychomycosis trial with the Noveon laser in the Journal of the American Podiatric Medical Association (JAPMA).

This is the third time that this preeminent peer-reviewed podiatric journal has published study results with the Noveon laser system.

The Clinical Correspondence published this month (J Am Podiatr Med Assoc 102(2): 169-171, 2012) describes at 270 days, the outcome of the pivotal human onychomycosis trial previously published in JAPMA. That previous paper presented data at 180 days (J Am Podiatr Med Assoc 100(3): 166–177, 2010)

The data presented in JAPMA from both publications is the following:

• At Day 180, 85% of the eligible treated toenails in the pivotal study were improved by clear nail linear extent (P = .0015); 65% showed at least 3 mm and 26% showed at least 4 mm of clear nail growth. At Day 270, 35% were determined to have further improved (beyond the day 180 measurement) by direct inspection, in linear clearing or increased clear area of the nail plate, 150 days after the last treatment.

• In the initial 180 day assessment, negative culture was observed in 42% of the eligible toes after only one treatment and 75% showed negative culture after three treatments. By Day 270, 38% of all treated toes were still considered mycologically cured, 150 days after the last treatment.

• At Day 180, one treated patient showed complete nail clearance and at Day 270 three patients attained a completely normal appearance, or ‘‘clinical cure’’ 150 days after the last treatment.

With this data, the authors conclude “In addition, the data clearly show this outcome can be affected regardless of the severity of the disease. As such, it gives strong indication that the Noveon laser offers a unique, low-risk option to potentially eliminate and then control the infecting fungal agent."

To date, the only study describing an Nd:YAG used on patients for onychomycosis therapy listed in the MEDLINE database treated eight patients, and can be found here: J Cosmet Laser Ther. 2011 Feb;13(1):2-5. Epub 2011 Jan 21. In the 8 patient study, the authors concluded "The optimal number of treatment sessions for each patient needs to be determined."

To date, complete data from 3 different human onychomycosis human clinical trials performed with the Noveon, have been peer-reviewed and published four times, since 2007.

The Noveon™ Podiatric Laser is a CE approved and FDA-cleared medical device for Podiatric and Dermatologic use, supported by research and human clinical data, which is fully automatic and completely frees clinicians from manually performing procedures.

I would suggest that Podiatric and Dermatologic professionals ask ANY laser company to "show me the peer-reviewed data" before making any treatment decision for their patients.

Best regards,

Dr. Eric Bornstein
Chief Science Officer
Nomir Medical Technologies
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  #373  
Old 26th March 2012, 08:53 PM
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Default Re: Laser treatment for nail fungus

Quote:
Originally Posted by hamish dow View Post
Mart:
Lased on 2 occassions.
2nd lasing was done at patients request @ 10 months or so after 1st lase. Toe was looking pretty much as it is now, but patient who had had it for a decade wanted "to be sure".
Dosage was a dot matrix pattern extending from mid distance between eponychium and IPJ to hyponycium area and laterally to @2mm beyond the sulci. This is now over 2 years since primary lase.

BLinda:
Conventional wisdom often cited that om "might" be treated, but nail dystrophy is permanent, my experience is different. Other than that it is a significant & potent, non pharmaceutical treatment option for om and bacteria, and has some interesting cosmetic interactions too. Not sure if it is said anywhere that it does the other stuff that you fail to see. It is a tool, needs to be understood and operated well to obtain best results, like most things.
Hi Hamish

Because the effect is is likley dose related and dosage doesnt seem to have been established, anedotes regarding dose may be helpful at this stage. "lased" over the nail is a bit hard to interpret. Could you be specific e.g. J/cm.sec or equivalent.

cheers

Martin
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  #374  
Old 30th March 2012, 04:42 PM
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Default Re: Laser treatment for nail fungus

Martin:
4 watts
200 mj per pulse
repletion rate at 20hz
pulse width 100 microseconds (10 pulses)
1mm spot size
1 longitudinal pass
1 horizontal pass
From my own observations there are a series of variable in play and one needs to be adjusting the use of the laser to overcome them on an individual basis, but using past observations as a guide. It has been a very interesting 3 years or so. It has been professionally rewarding to have been involved with it from the begining in this country has led me to change a great many of my previous held views on nails and mycotic involvement.
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  #375  
Old 30th March 2012, 06:07 PM
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Default Re: Laser treatment for nail fungus

Quote:
Originally Posted by hamish dow View Post
Martin:
4 watts
200 mj per pulse
repletion rate at 20hz
pulse width 100 microseconds (10 pulses)
1mm spot size
1 longitudinal pass
1 horizontal pass
From my own observations there are a series of variable in play and one needs to be adjusting the use of the laser to overcome them on an individual basis, but using past observations as a guide. It has been a very interesting 3 years or so. It has been professionally rewarding to have been involved with it from the begining in this country has led me to change a great many of my previous held views on nails and mycotic involvement.
Thanks Hamish

It seems likely that it will be difficult to do any kind of meta-analysis unless forthcoming studies have some way to normalize the dose. I see this as being problematic unless the actual energy transmitted can be properly measured and I am not sure if the manufacturers specs have been validated. It seems that the exposure parameters you used, those cited in the thread's initial paper and those we have recently tried here vary considerably.

My impression is that the therapeutic effect may be more related to tissue heating rather than other phenomena. If this is true then perhaps we should be more concerned with the measurable temperature effect than actual "photon dose".Did you attempt to monitor surface temperatures during your treatments?

We are planning to audit a series n= 80 mostly severe onychomycosis cases where the variable we were trying to loosely control was a dose which created maximum tolerated tissue heating. This seemed to be within range of surface measurement of 32-38 degrees C.

It would be great if others could post audit results even if not properly conducted studies. A bit "loosey goosey" but I will post some statistics of our audit results after we evaluate in about three months for anyone interested.

Perhaps at this stage that may provide some clues for most relevant variables.

Cheers

Martin

Foot and Ankle Clinic
1365 Grant Ave.
Winnipeg Manitoba R3M 1Z8
phone [204] 837 FOOT (3668)
fax [204] 774 9918
www.winnipegfootclinic.com
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  #376  
Old 10th April 2012, 03:48 PM
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Default Re: Laser treatment for nail fungus

Martin, my simple answer to you question about the surface temp, no. The PinPointe generates temp differently to the large spot retro engineered tat and hair lasers, and you are not alone in thinking the temp has a bearing on matters. I think creating a study from patient volunteers will be a different kettle of fish than that of pulling the info from treatments from paying patients. This is something which needs to be born in mind while disecting retro studies of my offerings. I am more interested in gaining experience and insight into how one clinically adapts to the infinately varying presentation and response, and then improving it. I am happy to offer the odd insight here and there from my work with this over the last 3 years or so but good luck to those who are interested in a pure acedemic pursuit. I shall watch with mild interest to see how they get on.
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  #377  
Old 26th April 2012, 12:19 AM
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Default Re: Laser treatment for nail fungus

Does anyone know the cost of the various machines?

Apologies if already asked.

Bob
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  #378  
Old 26th April 2012, 01:29 AM
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Default Re: Laser treatment for nail fungus

I'm pretty sure I read on a brochure by a supplier somewhere recently about A53k ?
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  #379  
Old 26th April 2012, 06:45 AM
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Default Re: Laser treatment for nail fungus

Quote:
Originally Posted by yesireebob View Post
Does anyone know the cost of the various machines?

Apologies if already asked.

Bob
Since I was in this market the last few years and things may change. I will list approximate prices then and leave off the names of the devices. But this will give you an idea. Most of the following have 1064 wavelength

30-35K for a device that was relatively portable FDA cleared and has no disposables

35-40K for a moderately high powered portable device modified to be marketed to DPMs (Some features removed) about 50-53 K for the full strength and full featured device.

40-42K for another moderately high powered less portable device, FDA cleared

~50K for a device that hit the market early and has FDA clearance. Used to have fees per use and mandatory marketing requirements, that I believe were finally decided to be a very bad idea. Some disposables

~20K(Quoted several years ago) for a non 1064 device that does not require the doctor to stay in the room during a somewhat lengthy treatment //also had severe per use expenses and expensive disposables and marketing requirements that have been modified or done away with.

~60- 70K for another device that is FDA cleared and marketed to podiatry

~60K for another non1064 device

At one time I was told, that to buy certain devices, $4,000 monthly marketing was a contract requirement and a per use fee of $600 was imposed. So as always, be careful with initial pricing when the goal is to get you on along term obligation that prohibits your ability to be competitive if the market in your area suddenly drops to $400 per treatment.

used or nonFDA regulated devices can be found on various webs sites. The Non FDA cleared devices listed above are all FDA approved or cleared for podiatry indications, just not nails specifically. If you burn a patient with a device not reviewed by the FDA, I would be worried.
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  #380  
Old 26th April 2012, 10:05 AM
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Default Re: Laser treatment for nail fungus

Quote:
Originally Posted by hamish dow View Post
Martin, my simple answer to you question about the surface temp, no. The PinPointe generates temp differently to the large spot retro engineered tat and hair lasers, and you are not alone in thinking the temp has a bearing on matters. I think creating a study from patient volunteers will be a different kettle of fish than that of pulling the info from treatments from paying patients. This is something which needs to be born in mind while disecting retro studies of my offerings. I am more interested in gaining experience and insight into how one clinically adapts to the infinately varying presentation and response, and then improving it. I am happy to offer the odd insight here and there from my work with this over the last 3 years or so but good luck to those who are interested in a pure acedemic pursuit. I shall watch with mild interest to see how they get on.
Thanks Hamish. At this stage I feel that anecdotal evidence is important; bit like treatment of verruca vulgaris, there is likely wide range of response and currently we don't even have a useful range of exposure to guide treatment. In the end tx parameters may need to be "titrated" and efficacy entirely empirical.

We should however strive for some objective measure of probability of success.

Cheers

Martin

Foot and Ankle Clinic
1365 Grant Ave.
Winnipeg Manitoba R3M 1Z8
phone [204] 837 FOOT (3668)
fax [204] 774 9918
www.winnipegfootclinic.com
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  #381  
Old 26th April 2012, 05:39 PM
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Default Re: Laser treatment for nail fungus

Quote:
Originally Posted by MAG1064 View Post
Since I was in this market the last few years and things may change. I will list approximate prices then and leave off the names of the devices. But this will give you an idea. Most of the following have 1064 wavelength

30-35K for a device that was relatively portable FDA cleared and has no disposables

35-40K for a moderately high powered portable device modified to be marketed to DPMs (Some features removed) about 50-53 K for the full strength and full featured device.

40-42K for another moderately high powered less portable device, FDA cleared

~50K for a device that hit the market early and has FDA clearance. Used to have fees per use and mandatory marketing requirements, that I believe were finally decided to be a very bad idea. Some disposables

~20K(Quoted several years ago) for a non 1064 device that does not require the doctor to stay in the room during a somewhat lengthy treatment //also had severe per use expenses and expensive disposables and marketing requirements that have been modified or done away with.

~60- 70K for another device that is FDA cleared and marketed to podiatry

~60K for another non1064 device

At one time I was told, that to buy certain devices, $4,000 monthly marketing was a contract requirement and a per use fee of $600 was imposed. So as always, be careful with initial pricing when the goal is to get you on along term obligation that prohibits your ability to be competitive if the market in your area suddenly drops to $400 per treatment.

used or nonFDA regulated devices can be found on various webs sites. The Non FDA cleared devices listed above are all FDA approved or cleared for podiatry indications, just not nails specifically. If you burn a patient with a device not reviewed by the FDA, I would be worried.
Thanks Mag, sounds a bit dodgey.
Are any of the devices cleared for use in Australia?
I have noticed a practice in Sydney marketing laser usage for OM.
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Old 26th April 2012, 07:57 PM
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Default Re: Laser treatment for nail fungus

Quote:
Originally Posted by yesireebob View Post
Thanks Mag, sounds a bit dodgey.
Are any of the devices cleared for use in Australia?
I have noticed a practice in Sydney marketing laser usage for OM.
To my knowledge there at least two practices in Sydney - each have a different laser. One uses the PinPointe system the other the Cutera.

I think you have to have the appropriote training (which the companies I believe provide) and also the appropriote signage around the clinic indicating laser usage for OH and S purposes. To my knowledge in NSW there are no restrictions on who uses the laser (Podiatrist or otherwise) if they have the appropriote training.

Own a nail salon? Maybe a good investment!
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Old 12th July 2012, 12:02 PM
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Default Re: Laser treatment for nail fungus

We have recently audited the effect of using the manufacturer recommended protocol for treatment of onychomycosis on approximately 80 cases using ND:YAG 1064 nm laser at four months follow up.

Unequivocally the results were poor. We were unable to find any significant improvement in any cases.

I think this begs the question why this seems so disparate from the few published papers and we are unable to explain this other than our selection process was different in 2 ways.

We intentionally selected patients with severe involvement because this would be typical of our clinical needs.

We omitted lab testing to confirm dermatophytes. Despite this we feel that the clinical presentation was very typical for onychomycosis evidenced by deep striated yellow disruption in majority cases so that appearance likely did not represent psoriatic cause of dystrophy in majority of cases.

Mechanical debridement prior to treatment was thorough and extensive as tolerated to nail bed so this was not a limiting factor.

The vast majority of cases seemed compliant to using antifungal foot powder BID to mitigate re-infection; frankly, given lack of any improvement in most I think that this measure was moot.

Cheers

Martin

Foot and Ankle Clinic
1365 Grant Ave.
Winnipeg Manitoba R3M 1Z8
phone [204] 837 FOOT (3668)
fax [204] 774 9918
www.winnipegfootclinic.com
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Old 12th July 2012, 01:23 PM
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Smile Re: Laser treatment for nail fungus

A simple double blind study can be performed. I would imagine a cold laser Helium neon type beam is used for targeting. This beam can be left on the active beam can be set to only turn on on every other patient in secret so the practioner is not aware that the effective beam is on or not. Then compare the two groups.
Has such a study been done ever or are they just comparing treated and untreated patients. I know many Dr.s using a laser are in addition treating with debridements and topical products that improve the appearance of the nail. Doing a true double blind study would eliminate this effect as both groups would get same topical care.
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Old 12th July 2012, 01:58 PM
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Default Re: Laser treatment for nail fungus

Quote:
Originally Posted by facfsfapwca View Post
A simple double blind study can be performed. I would imagine a cold laser Helium neon type beam is used for targeting. This beam can be left on the active beam can be set to only turn on on every other patient in secret so the practioner is not aware that the effective beam is on or not. Then compare the two groups.
Has such a study been done ever or are they just comparing treated and untreated patients. I know many Dr.s using a laser are in addition treating with debridements and topical products that improve the appearance of the nail. Doing a true double blind study would eliminate this effect as both groups would get same topical care.
I agree that a DBS would be ideal; problem I see though is that there needs to be some consensus regarding measuring dose. As I already mentioned this seems problematic and I feel that some "cruder" research is needed to evaluate likely useful dose range. Also, if as I suspect, to find out if there is strong evidence to suggest that ONLY superficial or very small zone of infection is likely to be responsive as seemed to be the case in our case audit. If you look at published data there seems to be a carefully selected cohort with mild infection.

Cheers

Martin

Foot and Ankle Clinic
1365 Grant Ave.
Winnipeg Manitoba R3M 1Z8
phone [204] 837 FOOT (3668)
fax [204] 774 9918
www.winnipegfootclinic.com
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Old 18th July 2012, 01:14 PM
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Default Re: Laser treatment for nail fungus

Treating onychomycoses of the toenail: clinical efficacy of the sub-millisecond 1,064 nm Nd: YAG laser using a 5 mm spot diameter.
Kimura U, Takeuchi K, Kino****a A, Takamori K, Hiruma M, Suga Y.
J Drugs Dermatol. 2012 Apr;11(4):496-504.
Quote:
BACKGROUND:
Onychomycosis is a relatively common fungal infection. Current treatments have limited applicability and low cure rates. Recently introduced laser therapy has shown to be a safe and effective treatment for onychomycosis. In this study, we evaluate a submillisecond Nd:YAG 1,064 nm laser for treating onychomycoses of the tonail.

METHODS:
Thirteen subjects (9 female, 4 male) with 37 affected toenails received 1 to 3 treatments 4 and/or 8 weeks apart with a sub-millisecond 1,064 nm Nd:YAG laser. Diagnosis of onychomycosis was confirmed with microscopy. Average follow-up time was 16 weeks post-final treatment. Photos were taken and degree of turbidity was determined using a turbidity scale (ranging from "0 = clear nail" to "10 = completely turbid nail") at each visit. Improvement in turbidity was determined by comparison of turbidity scores at baseline and 16-week follow-up on average. Efficacy was assessed by an overall improvement scale (0 to 4), which combined improvement in turbidity scores and microscopic examination. Overall improvement was classified as "4 = complete clearance" if the turbidity score indicated "0 = clear nail" accompanied by a negative microscopic result. No microscopic examination was performed unless the turbidity score showed "0 = clear nail."

RESULTS:
Treatments were well tolerated by all subjects and there were no adverse events. Of the 37 toenails treated, 30 (81%) had "moderate" to "complete" clearance average of 16 weeks post-final treatment. Nineteen toenails (51%) were completely clear and all tested negative for fungal infection on direct microscopic analysis. Seven (19%) toenails had significant clearance and four (11%) had moderate clearance.

CONCLUSIONS:
The preliminary results of this study show this treatment modality is safe and effective for the treatment of onychomycosis in the short term. Additional studies are needed to more fully assess the clinical and mycological benefits as well as optimize the treatment protocol and parameters.
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Old 18th July 2012, 02:23 PM
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Default Re: Laser treatment for nail fungus

Quote:
Originally Posted by NewsBot View Post
Treating onychomycoses of the toenail: clinical efficacy of the sub-millisecond 1,064 nm Nd: YAG laser using a 5 mm spot diameter.
Kimura U, Takeuchi K, Kino****a A, Takamori K, Hiruma M, Suga Y.
J Drugs Dermatol. 2012 Apr;11(4):496-504.
Interestingly we used similar intended dosage; in Kimura U et al the study the repetition varied between 1-3 X at four weeks intervals; we did 2 doses at two month interval. If you subdivide the Kimura et al cohort into hallux and the rest the results for the Hallux were extremely poor compared to lesser toes. We mostly did mostly Hallux onychomycosis.

Cheers

Martin

Foot and Ankle Clinic
1365 Grant Ave.
Winnipeg Manitoba R3M 1Z8
phone [204] 837 FOOT (3668)
fax [204] 774 9918
www.winnipegfootclinic.com
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Old 18th July 2012, 02:34 PM
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Default Re: Laser treatment for nail fungus

thats what we were taught as well, leave the cuticle alone...
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Old 18th July 2012, 03:29 PM
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Default Re: Laser treatment for nail fungus

Quote:
Originally Posted by NewsBot View Post
Treating onychomycoses of the toenail: clinical efficacy of the sub-millisecond 1,064 nm Nd: YAG laser using a 5 mm spot diameter.
Kimura U, Takeuchi K, Kino****a A, Takamori K, Hiruma M, Suga Y.
J Drugs Dermatol. 2012 Apr;11(4):496-504.
take a look at the images used for illustrative evidence of dramatic improvement, the hallux example looks like a traumatic nail outgrowth so the treatment may be moot, the other hallux example is minor involvement at onset. The superfical lesser toe mycosis seemed to respond well - this may also be true for topical drug approach for selective cohort. There is no example of deep severe infection illustrated which suggests that this was not seen.




Cheers

Martin



Foot and Ankle Clinic
1365 Grant Ave.
Winnipeg Manitoba R3M 1Z8
phone [204] 837 FOOT (3668)
fax [204] 774 9918
www.winnipegfootclinic.com
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Old 18th July 2012, 11:44 PM
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Default Re: Laser treatment for nail fungus

Hi Mart

We have been collecting data now for several months (including images) on patients managed with the 1064nm laser. The laser was the same unit, used by the same practitioner, with the same settings for each patient. I will send you some examples of severe infections before/after treatment and throughout treatment for your perousal.

I havent seen any comparisons yet as I dont want to form an opinion either way. I have had some of the patients email me though from the "severe" infection group (defined as all toes, pathology positive, no clear nail not infected) carrying on about the changes they are seeing in their nails....changes dont mean success though so I am sitting on the fence until I see some results.

We also have a less severe group (i.e. only partial infection of a single hallux nail with positive pathology and clear nail visible proximally). So we are trying to collect data from multiple groups.

TIme will tell. I'll update when I can.
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