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Laser treatment for nail fungus

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  #511  
Old 4th September 2013, 10:39 AM
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Default Re: Laser treatment for nail fungus

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Originally Posted by blinda View Post
Sorry Martin, don`t have a lot of time on my hands at the moment (got a houseful of offspring, plus mates & brother-in-law...) but you may find this interesting;

http://www.deepdyve.com/lp/springer-...s-gg0fOslcdb/1

You can view the full article for free, for a whole 5 minutes!
Thanks ...... I speed read this paper and "The effect of dermatophytes on cytokine production by human keratinocytes" ( I assume the Japanese paper other have mentioned).

I cant see how this is relevant to onychomycosis; the dematophyes only cause an inflammatory response when their metabolic products are presented to the immune system, this doesn't have any potential to clear onychomycosis.

Someone please explain how things could be otherwise.

The idea that laser can cause therapeutic altered gene expression to modulate an immune response within keratinocytes to treat onychomycosis seems moot even if true.

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  #512  
Old 4th September 2013, 11:56 AM
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Default Re: Laser treatment for nail fungus

Br J Dermatol. 2013 Aug 19. doi: 10.1111/bjd.12594. [Epub ahead of print]
A Second Look at Efficacy Criteria for Onychomycosis: Clinical and Mycological Cure.
Ghannoum M, Isham N, Catalano V.
Source
Center for Medical Mycology, Department of Dermatology, University Hospitals Case Medical Center, Cleveland, OH

although this paper is aimed towards drug intervention the difficulties it raises about useful clinical endpoint are relevant to laser studies too.
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  #513  
Old 4th September 2013, 02:18 PM
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Default Re: Laser treatment for nail fungus

You`re right, as the nail unit is virtually secluded from the body`s cell-mediated immunity, there are little, or no, antigens presented in comparison to the epidermis. However, there does appear to be some evidence that the nail does contain a strong innate immunity. See abstracts here;

http://www.ncbi.nlm.nih.gov/pubmed/14988673 - Innate immune defense of the nail unit by antimicrobial peptides.(I`m hoping to obtain the full article tomorrow)

http://www.karger.com/Article/Pdf/131412 - Immune Privilege and the Skin

This is a pretty good read (full article);

http://www.ijdvl.com/article.asp?iss...;aulast=Grover

Taken from the above;
Quote:
The nail apparatus has certain essential immunological differences as compared to that of skin. The nail unit is isolated from the body's cell-mediated immunity (CMI). [8] It is a site of relative immune privilege due to a very low level of expression of MHC (Major histocompatibility) Class 1a antigens, local production of potent immunosuppressive agents, dysfunction of antigen presenting cells (APC) and inhibition of Natural Killer (NK) cell activity. [8] Also, dermatophytes are strongly keratinophilic organisms. This is because of their ability to form perforating organs due to which they quickly digest keratin. [9] On the other hand, there are various protective mechanisms at play as well. Nail unit has been shown to possess a strong innate immunity. [10] An increased local expression of antimicrobial peptide (human cathelicidin LL-37) has been shown in the study by Dorschner et al. [10] Cathelicidin LL-37 is not expressed in human skin under normal circumstances, but it gets induced upon exposure to infection or inflammation. However, it is strongly expressed in the nail unit. Being a soluble antimicrobial, it has been shown to have potent activity against Pseudomonas aeruginosa[11] and Candida albicans. [10] In addition, a differential distribution of immune cells has been observed in different parts of the nail apparatus. There is a high density of CD4+ cells in the proximal nail fold (PNF) and very low density in the proximal nail matrix (PNM). [12] CD8+ T cells are rarely seen in and around PNF, nail bed, and PNM. The density of Langerhans cells is higher in epithelium of the PNF and nail bed as compared to that of the nail matrix. [12] The Langerhans cells and macrophages in the nail matrix are functionally impaired with respect to their capability of antigen presentation. [1]

In short, due to a lack of effective cell-mediated immunity, the nail apparatus is susceptible to invasion by fungal organisms, if it gets exposed due to various predisposing factors. Hence, OM is usually a chronic infection not associated with inflammation.
So, maybe those AMPs could be induced by inflammation?
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Old 4th September 2013, 03:10 PM
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Default Re: Laser treatment for nail fungus

Quote:
Originally Posted by blinda View Post
You`re right, as the nail unit is virtually secluded from the body`s cell-mediated immunity, there are little, or no, antigens presented in comparison to the epidermis. However, there does appear to be some evidence that the nail does contain a strong innate immunity. See abstracts here;

http://www.ncbi.nlm.nih.gov/pubmed/14988673 - Innate immune defense of the nail unit by antimicrobial peptides.(I`m hoping to obtain the full article tomorrow)

http://www.karger.com/Article/Pdf/131412 - Immune Privilege and the Skin

This is a pretty good read (full article);

http://www.ijdvl.com/article.asp?iss...;aulast=Grover

Taken from the above;


So, maybe those AMPs could be induced by inflammation?
That looks like an interesting avenue, I'll see if I can track this down too

Cheers

Martin
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  #515  
Old 4th September 2013, 07:50 PM
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Default Re: Laser treatment for nail fungus

Quote:
Originally Posted by blinda View Post
You`re right, as the nail unit is virtually secluded from the body`s cell-mediated immunity, there are little, or no, antigens presented in comparison to the epidermis. However, there does appear to be some evidence that the nail does contain a strong innate immunity. See abstracts here;

http://www.ncbi.nlm.nih.gov/pubmed/14988673 - Innate immune defense of the nail unit by antimicrobial peptides.(I`m hoping to obtain the full article tomorrow)

http://www.karger.com/Article/Pdf/131412 - Immune Privilege and the Skin

This is a pretty good read (full article);

http://www.ijdvl.com/article.asp?iss...;aulast=Grover

Taken from the above;


So, maybe those AMPs could be induced by inflammation?
I speed read the papers from your citations + a couple of others. Essentially my understanding is that, as you mentioned, demonstration of antimicrobial activity from APMs isolated from nail so far is limited to Pseudomonas aeruginosa and Candida albicans.

I agree this is interesting but it remains a long stretch to speculate that the activity might extend to most common dermatophytes associated with OM - even greater to think that laser therapy might up-regulate AMP production favorably to have therapeutic effect.

For time being at least there seems no evidence to support view that innate immune response can be therapeutically manipulated to treat OM.

I can email you papers if you have trouble sourcing them

Cheers

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  #516  
Old 4th September 2013, 09:44 PM
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Default Re: Laser treatment for nail fungus

Lasers promising for onychomycosis treatment
Quote:
Lasers are playing a key role in the treatment of onychomycosis, with cure rates exceeding that of terbinafine in most cases, Dr. Jill S. Waibel said at a meeting sponsored by SkinCare Physicians and Northwestern University.
Quote:
All infectious agents can be killed by heat except prions, which makes laser therapy a promising option for onychomycosis, Dr. Waibel said. The mechanism of action is not fully understood, but she shared three hypotheses. The first is that water in the keratin of the nail absorbs the laser energy and creates nonspecific bulk heating, which denatures fungal organelles. The second hypothesis is that free radicals are created by the laser, and these kill the dermatophyte. The third hypothesis is that microscopic selective photothermolysis occurs in Trichophyton species that contain melanin in their cell walls. Microcavitation and acoustic shock waves are created, which decapsulate the spores. The mechanism of action "is probably a combination of all three," she speculated.
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  #517  
Old 5th September 2013, 12:49 AM
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Default Re: Laser treatment for nail fungus

Quote:
Originally Posted by Mart View Post
I speed read the papers from your citations + a couple of others. Essentially my understanding is that, as you mentioned, demonstration of antimicrobial activity from APMs isolated from nail so far is limited to Pseudomonas aeruginosa and Candida albicans.

I agree this is interesting but it remains a long stretch to speculate that the activity might extend to most common dermatophytes associated with OM - even greater to think that laser therapy might up-regulate AMP production favorably to have therapeutic effect.

For time being at least there seems no evidence to support view that innate immune response can be therapeutically manipulated to treat OM.

I can email you papers if you have trouble sourcing them

Cheers

Martin

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Thanks Martin,

I agree, my posts were pure speculation as you asked how inflammation could play a role.

It would be interesting to see the effect of the AMP Cathelicidin LL-37 on dermatophyte infection, not just bacterium and yeasts. So many questions....
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  #518  
Old 5th September 2013, 01:06 AM
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Default Re: Laser treatment for nail fungus

Quote:
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Hi

I am curious about what you regard as good result for om and vp treatment measure?

cheers Martin

Sent from my Iphone
Without going into technicalities ,I would say a good result is if they are cured.
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  #519  
Old 5th September 2013, 01:09 AM
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Without going into technicalities ,I would say a good result is if they are cured.
Yep, but clinical or mycological?
http://www.ncbi.nlm.nih.gov/pubmed/17307276
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Old 5th September 2013, 01:45 AM
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Default Re: Laser treatment for nail fungus

Quote:
Originally Posted by blinda View Post
Yep, but clinical or mycological?
http://www.ncbi.nlm.nih.gov/pubmed/17307276
Both, but, as has been discussed previously in this thread, the nail does not always look totally 'normal' after resolution of the infection.

Most of the potential patients I have discussed the procedure with are happy to accept a nail with some thickening or distortion, as long as the appearance is greatly improved. I have also explained that it is a team effort, and that they have to be vigilant in keeping athletes foot at bay, and spraying shoes, washing hosiery at a higher temperature, etc. to stop re-infection.
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  #521  
Old 18th October 2013, 08:50 PM
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Default Re: Laser treatment for nail fungus

Keys To Using Lasers When Treating Onychomycosis
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Old 1st January 2014, 01:20 PM
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Default Re: Laser treatment for nail fungus

A review of lasers and light for the treatment of onychomycosis.
Ortiz AE, Avram MM, Wanner MA.
Lasers Surg Med. 2013 Dec 24.
Quote:
BACKGROUND AND OBJECTIVE:
Onychomycosis is a common fungal infection that affects many individuals. Systemic therapies are effective, but are limited by their side effects and potential for hepatotoxicity. Topical therapies have less serious side effects, yet provide only limited efficacy due to their inability to penetrate the nail plate. These limitations have led to the investigation of laser and light-based modalities as alternative treatment options for onychomycosis. This article will provide an overview and critical assessment of the field of laser and other energy-based treatments for onychomycosis.
STUDY DESIGN/MATERIALS AND METHODS:
A literature search was conducted on laser and light-based treatments for onychomycosis.
RESULTS:
Early data are promising, however, many of these studies are small or poorly designed.
CONCLUSION:
Further evaluation and larger studies are needed to determine the optimal light source, pulse duration, and treatment schedule for long-term success.
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Old 1st January 2014, 06:57 PM
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Default Re: Laser treatment for nail fungus

Want to see how well laser fungal toenail treatment works? Just read the reviews of the podiatrist who currently does a lot of laser nail fungal treatments here in Sacramento.
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Old 29th January 2014, 03:02 PM
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Default Re: Laser treatment for nail fungus

hi hamish
once met you in glasgow socp conference.
Just moving into private practice and was thinking of using laser.
Have trained with omega on cold therapy systems but unsure of the effects with OM nails.
talked to a company about the yag lasers but ££££££££ well over what I could afford.
now looking at the yag laser and power out-put i could get a standard yag for £1000 and seems to do the same.

what's the lowdown i would be very greatful for any advice
thanks tony
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Old 29th January 2014, 04:12 PM
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Default Re: Laser treatment for nail fungus

Quote:
Originally Posted by Kevin Kirby View Post
Want to see how well laser fungal toenail treatment works? Just read the reviews of the podiatrist who currently does a lot of laser nail fungal treatments here in Sacramento.
I'm not talking about that particular Podiatrist as I know nothing about them or what they actually treat. However as people in this thread have demonstrated there are positive outcomes to laser use on OM nails.

I could apply the bad ratings system to anything in Medicine and i'm sure it would highlight unsuccessful treatments in any management plan or action. I don't believe any of us could say they fix every patient that walks though the front door - and if you honestly believe that then you are dreaming! Whether its orthotics, laser, oral terbinafine, ingrown toenails OR surgery of any kind OR medicine of any kind there will always be poor reports of satisfaction outcomes.
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Old 29th January 2014, 04:49 PM
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Default Re: Laser treatment for nail fungus

so what type of laser works best on om nails?
any clinical evidence that is not controversial

thanks
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  #527  
Old 10th February 2014, 04:07 PM
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Default Re: Laser treatment for nail fungus

Quote:
Originally Posted by tonywatson12 View Post
so what type of laser works best on om nails?
any clinical evidence that is not controversial

thanks

Ortiz et al published a good review recently of evidence and speculation to date which if you are unfamiliar with this subject should be informative. That way you should be able to navigate the hype, sales pitch and the evidence.

"In summary, studies of these devices are limited in
number and quality. Larger randomized, controlled, and
blinded studies with objective assessments for “cure” of
onychomycosis are needed. The majority of currently
utilized laser systems for onychomycosis, such as the Nd:
YAG laser, are maximally absorbed by water and likely
result in nonspecific heating of the host tissue and
suboptimal bulk heating of dermatophytes. Given the
somewhat promising early results, one can speculate that
the heating of the host tissue may improve circulation in
the area, possibly leading to a greater host response. The
heating of dermatophytes is limited due to extreme target
temperatures necessary for destruction of the spore and
hyphae without the destruction of normal tissue; thus,
leading to fungistatic rather than fungicidal properties.
Many of the current studies do not address the rate of
recurrence after therapy, making it difficult to determine
true efficacy of the technologies. Similar to available oral
and topical treatments, patients will likely require long term
maintenance therapy to prevent recurrence. The
optimal number of treatments, treatment schedule,
wavelength, and pulse duration remains unclear. Future
investigation should aim for more selective targets within
dermatophytes in order to achieve fungicidal rather than
fungistatic effects."

Lasers Surg Med. 2013 Dec 24. doi: 10.1002/lsm.22211. [Epub ahead of print]
A review of lasers and light for the treatment of onychomycosis.
Ortiz AE, Avram MM, Wanner MA.
Author information
Abstract
BACKGROUND AND OBJECTIVE:
Onychomycosis is a common fungal infection that affects many individuals. Systemic therapies are effective, but are limited by their side effects and potential for hepatotoxicity. Topical therapies have less serious side effects, yet provide only limited efficacy due to their inability to penetrate the nail plate. These limitations have led to the investigation of laser and light-based modalities as alternative treatment options for onychomycosis. This article will provide an overview and critical assessment of the field of laser and other energy-based treatments for onychomycosis.
STUDY DESIGN/MATERIALS AND METHODS:
A literature search was conducted on laser and light-based treatments for onychomycosis.
RESULTS:
Early data are promising, however, many of these studies are small or poorly designed.
CONCLUSION:
Further evaluation and larger studies are needed to determine the optimal light source, pulse duration, and treatment schedule for long-term success. Lasers Surg. Med. © 2013 Wiley Periodicals, Inc.

Cheers

Martin

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Old 10th February 2014, 04:31 PM
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Default Re: Laser treatment for nail fungus

reminds me of how acupuncture in podiatry was viewed back in the days before it become popular !
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Old 13th March 2014, 08:11 PM
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Default Re: Laser treatment for nail fungus

Press release:
Nomir Medical Announces FDA Clearance for Noveon NaiLaser
Quote:
WOODMERE, N.Y., March 13, 2014; Nomir Medical Technologies, Inc., the world leader in antimicrobial photobiology, today announced that the US Food and Drug Administration has granted clearance to the company's Noveon NaiLaser for the treatment of onychomycosis (toenail fungus). (See clearance below)

Jack Kay, Nomir CEO, explained, "We developed the Noveon® NaiLaser™ to meet the needs of physicians for a safer, more effective treatment option for toenail fungus sufferers, with an ergonomic, hands-free design to maximize doctor comfort and minimize labor costs". Dr. Kay continued, "The FDA clearance provides assurance for physicians and patients that the Noveon provides effective treatment for onychomycosis."

Dr. Eric Bornstein, the inventor of the Noveon and Nomir's Chief Science Officer, describes why the Noveon NaiLaser is a more effective solution than other laser options: "Noveon's onychomycosis data has been published an unprecedented three times in the Journal of the American Podiatric Medical Association. As reflected in our pivotal trial, retrospective trials, and the new FDA indications for use language, our therapy recognizes that a patient's tinea pedis (foot fungus) must also be treated to see improvement in onychomycosis. This is a net positive, as we are the first laser in the industry to evolve with clearance language that recognizes this major etiology for onychomycosis."

Support from the Medical Community

"As someone who has evaluated results through several periods of clinical studies and found the Noveon to be very effective, I was glad to learn about the FDA's approval," said Dr. Bryan Markinson, Chief of Podiatric Medicine at the Leni and Peter W. May Department of Orthopedic Surgery of the Icahn School of Medicine at Mount Sinai[1]. Dr. Markinson continued, "Unlike other lasers that rely on heat, the Noveon laser uses photobiology with specific light wavelengths at low power intervals to achieve its results and is better tolerated by the patient during treatment. I have been involved with the development of the Noveon from the earliest periods of actual design, and it remains the only laser treatment for onychomycosis with published results in peer reviewed literature."

Dr. Warren S. Joseph, a specialist in lower extremity infectious diseases noted, "Few of the other lasers have the results of their clinical trials published in the peer reviewed medical literature. However, results with the Noveon show 85% of the eligible treated toenails showing improvement by clear nail in their pivotal trial published in JAPMA." Dr. Joseph continued, "I am pleased with the new and unique indication for use language, as it distinguishes the Noveon laser as now being in line with the established understanding that describes the necessity of tinea pedis treatment along with onychomycosis therapy as the two conditions are inexorably linked".

Dr. Paul Lazar, a New York podiatrist agreed, "I have seen a real difference in treatment results compared to conventional drug therapy and to other lasers I have used." Dr. Lazar continued, "I appreciate how with automatic operation and the ability to treat up to four toes at the time, the Noveon NaiLaser saves valuable time for my patients and me."
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  #530  
Old 21st March 2014, 05:58 AM
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Default Re: Laser treatment for nail fungus

Dr. Bornstein.

At the risk of exposing the fact that I have not read all preceeding 18 pages, can you tell me why your combined wavelengths 870 and 930 are more lethal to fungus and why almost everyone else is using 1064?

Thanks.
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Old 21st March 2014, 07:10 AM
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Default Re: Laser treatment for nail fungus

Bennepod:

The Noveon®, is a near-infrared diode laser system that is specifically designed to use only the 870nm and 930nm wavelengths. This device, combining the 870nm and 930nm energies in a multiplexed beam, has shown a unique antimicrobial action spectrum in-vitro, in vivo, and in 6 human IRB controlled studies. (1-4)

The device has also completed a 4-site blinded, randomized and IRB approved pivotal study and a 199 patient retrospective study where the data has been approved by the FDA for the treatment of Onychomycosis. With this approval, the Noveon treats "hands free", up to 4 toes simultaneously. The Pivotal study was also published in JAPMA and can be found here: http://www.alnc.com.au/uploads/1/3/3...6/japma_ii.pdf

The photo-biological mechanism of action has been published in the prestigious Journal Photochemistry and Photobiology. (1)

A review of our system vs Nd:YAG lasers has been published in JAPMA. (2)


1. Bornstein E., Hermans W., Gridley S., and Manni J. Near infrared Photo-inactivation of bacteria and fungi at physiologic temperatures. Photochemistry and Photobiology, Published Online 26 Aug 2009

2. Bornstein ES: A Review of Current Research in Light-Based Technologies for Treatment of Podiatric Infectious Disease States. Journal of the American Podiatric Medical Association Volume 99 Number 4 348-352 2009

3. Bornstein, E.S., Y.P. Krespi, A. Robbins, J. Wlassich, E. Sinofsky (2008) Antimicrobial resistance reversal at physiologic temperatures in MRSA in the nares with an 870 nm and 930 nm dual wavelength noveon laser. 2008 Tissue Engineering and Regenerative Medicaine International Society North America Meeting Abstracts.

4. Bornstein, E.S., A.H. Robbins, M. Michelon (2008) Photo-inactivation of fungal pathogens that cause onychomycosis in vitro and in vivo with the noveon dual wavelength laser system. 2008 New Cardiovascular Horizons Meeting Abstracts.


The 1064 lasers work via ablation. The ablation interaction has been modified, to act as a laser for OM treatment with a fully thermal ablative interaction.

This Nd:YAG work has been described by Elewski et al in the following manner:

New Results Challenge Nd:YAG Laser Effectiveness for Onychomycosis - EXPERT ANALYSIS FROM THE ANNUAL MEETING OF THE AMERICAN ACADEMY OF DERMATOLOGY (2012)

Boni Elewski MD, conducted in vitro temperature studies, and then treated 10 patients with an Nd:YAG laser, and found that to kill three different types of fungus with an Nd:YAG Laser, the following temperatures and times had to be met.

- T rubrum 50° C for 15
- E. floccosum 50° C for 10 minutes
- Scytalidium 55° C for 5 minutes.


Human Results:

" nail temperatures that reach 40-41° C (with an Nd:YAG laser) cause enough pain for patients to pull away, and the maximum nail temperature patients could tolerate was 45° C," said Dr. Elewski, professor of dermatology at the University of Alabama at Birmingham.”

This means that for the Nd:YAG lasers, you mush heat past the level of possible tissue damage to kill the fungus. The Noveon system is photo-biologic, and does not increase temperatures of the nail past 103F (39 C). This has been peer reviewed and published in JAPMA and Photochemistry. (1,2)

A series of video’s describing the Noveon can be viewed here:

1. For doctors seeking to understand how the Noveon works: Noveon Technology http://www.noveoninternational.com/p.../science-video

2. For doctors who would like to hear from podiatrists using the Noveon Naillaser: Physicians’ Video – http://www.noveoninternational.com/p...hysician-video

3. For more patient information about the Noveon technology: Patient Video - http://www.noveoninternational.com/p.../patient-video

Best regards,

Dr. Eric Bornstein
Chief Science Officer
Nomir Medical Technologies
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Old 21st March 2014, 08:29 AM
Bennepod Bennepod is offline
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Default Re: Laser treatment for nail fungus

Dr. Bornstein
Thanks for your thorough and speedy reply.
What are the limitations of the laser? for instance, regarding total dystrophic onychomycosis and endonyx? and other considerations re hypertrophy of nail and pigmentation?

Thanks again.
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  #533  
Old 21st March 2014, 08:41 AM
Dr. Eric Bornstein Dr. Eric Bornstein is offline
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Default Re: Laser treatment for nail fungus

Dear Bennepod:

We have successfully treated dystrophic onychomycosis, endonyx onychomycosis along with hypertrophic and pigmented onychomycosis.

To see these cases, please go to the following link, which is our 199 patient (not yet published) retrospective study:
http://midwest.us.com/images/OM_Retr...hite_Paper.pdf

These cases are from various podiatrists in the field that have been using the Noveon for the last two years. In most of these difficult cases, I would not even know where to begin with an Nd:YAG and the temperature/heat issues.

best regards,

Dr. Eric Bornstein DMD
Chief Science Officer
Nomir Medical Technologies
www.noveoninternational.com
ebornstein@nomirmedical.com
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Old 21st March 2014, 12:31 PM
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Default Re: Laser treatment for nail fungus

Hi Eric

The methods and results of your work seem extremely thorough and compelling.

Published in "Near infrared Photo-inactivation of bacteria and fungi at physiologic temperatures" the blinded, temperature controlled, in vitro kill experiments showed rates of 100% at below 42.5 degree C for T rubrum and C albicans for all six tests. I was unable to find a similar experiment published elsewhere - do you know if this has been tried outside of your study?

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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  #535  
Old 21st March 2014, 12:50 PM
Dr. Eric Bornstein Dr. Eric Bornstein is offline
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Default Re: Laser treatment for nail fungus

Quote:
Originally Posted by Mart View Post
Hi Eric

The methods and results of your work seem extremely thorough and compelling.

Published in "Near infrared Photo-inactivation of bacteria and fungi at physiologic temperatures" the blinded, temperature controlled, in vitro kill experiments showed rates of 100% at below 42.5 degree C for T rubrum and C albicans for all six tests. I was unable to find a similar experiment published elsewhere - do you know if this has been tried outside of your study?

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

Dear Martin:

Nomir Medical has proprietary ownership of the two wavelengths that we use 870nm/930nm, so these experiments have not been done by another group. However, we have done a large amount of side-by-side work (unpublished) that is summarized below against E. coli.

Nomir Tested Wavelengths and Combinations Against E. coli

Wavelengths Impact on E. coli
810 nm alone 8% kill
830 nm alone 8% kill
870 nm alone 27% kill
885 nm alone 23% Growth
930 nm alone 100% kill
810 nm + 870 nm 0% kill
870 nm + 885 nm Mild growth
810 nm + 930 nm Moderate Growth

885 nm + 930 nm 18% kill
870 nm + 930 nm 98% kill

Only the wavelengths in our unique combination and dose, have shown non-thermal antimicrobial activity.

As we have published our data in so many different venues (in vitro and in vivo), from 2008-2012, and with the greater podiatric community using our OM device successfully for 2+ years, I am fairly confident of the wavelength's specific chromophore absorption for photo-biologic antimicrobial activity. A list of our publications is below.

Bornstein, E.S., Y.P. Krespi, A. Robbins, J. Wlassich, E. Sinofsky (2008) Antimicrobial resistance reversal at physiologic temperatures in MRSA in the nares with an 870 nm and 930 nm dual wavelength noveon laser. 2008 Tissue Engineering and Regenerative Medicine International Society North America Meeting Abstracts.

Bornstein, E.S., A.H. Robbins, M. Michelon (2008) Photo-inactivation of fungal pathogens that cause onychomycosis in vitro and in vivo with the noveon dual wavelength laser system. In Proceedings of the 9th Annual New Cardiovascular Horizons, p.72, New Orleans, LA, September 10–13, 2008. New Cardiovascular Horizons, Lafayette, LA.

Bornstein E.S. (2009) A Review of current research in light-based technologies for treatment of podiatric infectious disease states. J. of the Am. Pod. Med. Assoc. 99 (4), 348-352.

Bornstein E.S. (2009) Treatment of onychomycosis using the noveon® dual-wavelength laser. FDA Pivotal Study data presented at Council for Nail Disorders 13th Annual Meeting, San Francisco, CA, March 5, 2009.
Bornstein E.S. (2009) A Review of current research in light-based technologies for treatment of podiatric infectious disease states. J. of the Am. Pod. Med. Assoc. 99 (4), 348-352.

Landsman, A. et al. (2010) Treatment of Mild, Moderate and Severe Onychomycosis Using 870nm and 930nm Light Exposure. Journal of the American Podiatric Medical Association • Vol 100 • No 3 • May/June 2010

Bornstein E., S. Gridley, and P. Wegender (2010) Photodamage to Multidrug-resistant Gram-positive and Gram-negative Bacteria by 870 nm/930 nm Light Potentiates Erythromycin, Tetracycline and Ciprofloxacin. Photochemistry and Photobiology, 2010, 86: 617–627

Landsman, Adam S., and Alan H. Robbins. "Treatment of Mild, Moderate, and Severe Onychomycosis Using 870-and 930-nm Light Exposure Some Follow-up Observations at 270 Days." Journal of the American Podiatric Medical Association 102.2 (2012): 169-171.

Thank you for the question.

If you have interest in the system, our Canadian distributor can be found here:
http://magne-tec.com/noveon/

Best Regards,

Dr. Eric Bornstein
Chief Science Officer
Nomir Medical Technologies
ebornstein@nomirmedical.com
www.noveoninternational.com
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Old 21st March 2014, 10:13 PM
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Default Re: Laser treatment for nail fungus

Toenail onychomycosis treated with a fractional carbon-dioxide laser and topical antifungal cream
Eun-Hwa Lim et al
Journal of the American Academy of Dermatology; Article in Press
Quote:
Background
Traditional pharmacotherapy for onychomycosis has low to moderate efficacy and may be associated with adverse reactions and medication interactions limiting its use in many patients.
Objective
We evaluated the clinical efficacy and safety of a fractional carbon-dioxide laser with topical antifungal therapy in the treatment of onychomycosis.
Methods
In all, 24 patients were treated with fractional carbon-dioxide laser therapy and a topical antifungal cream. The laser treatment consisted of 3 sessions at 4-week intervals. Efficacy was assessed based on the response rate from standardized photographs, a microscopic examination of subungual debris, and subjective evaluations.
Results
Among the patients, 92% showed a clinical response and 50% showed a complete response with a negative microscopic result. The factors that influenced a successful outcome were the type of onychomycosis and the thickness of the nail plate before treatment. The treatment regimen was well tolerated and there was no recurrence 3 months after the last treatment episode.
Limitations
The study followed up only 24 patients and there were no relevant treatment controls.
Conclusions
Fractional carbon-dioxide laser therapy, combined with a topical antifungal agent, was effective in the treatment of onychomycosis. It should be considered an alternative therapeutic option in patients for whom systemic antifungal agents are contraindicated.
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