Laser Nail Fungal Infection Treatment
Fungal nail infections can be difficult to cure, and they typically don’t go away without antifungal treatment. The fungus can spread to other areas of the hands or feet, and can be mild with purely cosmetic implications, or more severe with pain, low self-esteem and embarrassment due to disfigurement.
What causes nail fungal infection?
Nail fungal also known as Onychomycosis (tinea unguium)” is an extremely common and specific fungal infection caused by a fungi called ketinophilic dermatophyte Trichophyton rubrum that infects the nail bed and matrix (Glaser, Lockwood & Lisy 2013).
Current research shows that fungal nail infections causes includes dermatophytic fungi, yeasts, saprophytic moulds and/or bacteria (Glaser, Lockwood & Lisy 2013).
Fungal nail infections are more common among people who are of lower socioeconomic background, older, male, diabetic, obese, immune deficient (such as HIV or cancer), lacking personal hygiene, and environmental factors such as fungal contamination of swimming pools, public toilets and communal bathing facilities.
Different types of onychomycosis (nail fungal infection):
Distal subungual onychomycosis (DSO) invades the distal nail plate progressing proximally to invade the nail bed and underside of the nail plate and is the most common form of onychomycosis caused by T. rubrum. Nails can become brittle, thickened and discoloured with pieces of nail breaking away (Glaser, Lockwood & Lisy 2013).
White superficial onychomycosis (WSO) results in superficial infection of the nail plate indicated by the presence of ‘white islands’; it occurs mainly on toenails. As the infection consolidates, onycholysis can occur as the keratin breaks down (Glaser, Lockwood & Lisy 2013).
Proximal subungual (white) onychomycosis (PSO) or (PSWO) where T. rubrum colonisation of the newly formed nail plate via the proximal nail fold, progressing distally with fingernails and toenails equally affected, is the least common form of onychomycosis in healthy adults; but is commonly isolated from immunocompromised individuals. Proximal subungual onychomycosis is an early clinical marker of HIV (Glaser, Lockwood & Lisy 2013).
Total dystrophic onychomycosis (TDO) can primarily due to chronic mucocutaneous candidiasis. Individuals who often have their hands in water or suffer from hyperhidrosis, and wear occulusive footwear can be infected with candida onychomycosis, caused by Candida spp (Glaser, Lockwood & Lisy 2013).
What if nail fungal infection is left untreated?
Poor cosmetic appearance of nails can seriously impact an individual’s employment prospects, personal relationships and general lifestyle. Onychomycotic toe nails which become very thick and malformed can significantly impact mobility and limit footwear choice. Onychomycotic infections tend to be long term (>12 months) and recalcitrant (Glaser, Lockwood & Lisy 2013).
Other potential complications includes foot pain, spread of fungus, widespread infection and loss of nails.
What are the treatment options for nail fungal infection?
The most commonly utilised current treatment methods are topical and oral treatments. Oral medications can have side effects such as altered liver function. Topical treatments for nail infections are problematic for several reasons. They require chemical penetrations of the nail plate and bed to reach the target infected tissue resulting in reported efficacy rates between 5% and 8%. A lengthy treatment period of three to 12 months is required. Topical applications are not a treatment option for obese clients, individuals who are unable to reach their feet and older individuals with poor eyesight and reduced manual dexterity. Thus there is a need for more effective treatment. In recent years, device based on-invasive therapies such as laser, ultrasound, iontophoresis and photodynamic therapies have been applied to onychomycotic infections (Glaser, Lockwood & Lisy 2013).
How does laser work in treating nail fungal infection?
Laser has the potential to eliminate microorganisms. It has a significant inhibitory effect and growth on T. rubrum (type of fungus). The laser has the ability to penetrate under the nail plate in order to reach the fungi colonies of the nail bed and nail matrix. The laser selectively deliver laser energy to fungi while respecting the surrounding healthy tissues (Onder et al. 2013).
Effective laser treatment relies on the theory of selective photothermolysis. It absorbs a particular light wavelength. Laser have different wavelengths. Melanin present in skin and Trichophyton rubrum species cell walls, absorbs the 1064nm wavelength produced by the Q-swtiched Nd:YAG laser. Whereas the 532nm wavelength of the Q-switched Nd:YAG laser is absorbed by the red chromophore xanthomegnin abundant in T. rubrum (Glaser, Lockwood & Lisy 2013).
How many laser treatment are recommended in treating nail fungal infection?
A minimum of 4 sessions is recommended. Treatment varies and depends on the response to the treatment. It is recommended to have treatments once every 2 weeks for the first 3 sessions and every 6 weeks thereafter (Weber et al. 2018). The treatment will be reassessed if further treatments are required and to provide other recommendations.
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Glaser, HJ & Lockwood, C & Lisy, K 2013, “The Effectiveness of Laser Treatments for Onychomycosis in Adults in the Community: a Systemic Review Protocol”, JBI Database of Systematic Reviews & Implementation Reports, vol. 11, no. 10, pp. 1-15.
Kalocasidis, Onder, M, Trakatelli, MG, Richert, B & Fritz, K 2013, “The Effect of Q-Swtiched Nd:YAG 1064 nm/532 nm Laser in the Treatment of Onychomycosis In Vivo”, Dermatology Research and Practice, vol 2013.
Weber, GC, Firouzi, P, Baran, AM, Bölke,E, Schrumpf, H, Buhren, BA, Homey, B & Gerber, PA 2018, “Treatment of onychomycosis using a 1064-nm diode laser with or without topical antifungal therapy: a single-center, retrospective analysis in 56 patients”, European Journal of Medical Research, vol. 23, no. 53, pp. 1-8.