Onychomycosis, or nail fungus, is one of the most common nail diseases in the adult population and accounts for 1/3 of all fungal skin diseases. They are often affected by their big toes.
This is due to dermatophyte Trichophyton rubrum and Trichophyton mentagrophytes (they affect nails in 90% of cases), mold fungi (Aspergillus niger and Candida). If we talk about who suffers from onychomycosis more often, then these are men, and if at the age of 40 to 60 years old they get 15-20%, then at 70, the percentage of cases increases to 48%.
It is almost impossible to independently determine whether you suffer from onychomycosis, because the disease looks like psoriasis, atopic dermatitis , and lichen planus. However, if the following diseases and conditions are present in the history, the risk of infection of the nails with a fungus increases significantly.
- Low local immunity
- Mechanical damage to the nail;
- Somatic diseases: oncological diseases, diabetes, obesity, vascular diseases, endocrine pathologies;
- Special physiological conditions, for example, menopause;
- Malnutrition of the nail bed;
- Chemical factors: constant contact with detergents, water, etc.
It does not happen that the fungus immediately appears on the nail plates. First, the mushrooms affect the skin of the hands or feet, and only then it is infected, starting from the marginal end and ending with the matrix, the nail.
Currently, the standard common treatment for onychomycosis (nail fungus) is systemic antifungal therapy. Due to the fact that the nail plate is dense in its structure, local preparations cannot penetrate through it and accumulate. This is the main reason that dermatologists prescribe systemic drugs for the treatment.
This approach is also not perfect: systemic therapy is a long process and takes from 6 to 12 months. Such a long-term use of expensive drugs in high doses negatively affects the state of the body as a whole, and the effectiveness in some cases is from 40 to 80%, sometimes systemic therapy is completely contraindicated due to a significant general toxic effect.
We are talking about patients with pathologies of the liver, children, pregnant and lactating women.
Today, the effectiveness of the direct effect of laser radiation on fungal strains and its possible fungistatic potential is being actively studied. The clinical results of studies conducted over the past five years are encouraging and convincing: treatment of onychomycosis with a laser is painless and highly effective.
Apparatus for the treatment of nail fungus
FDA approved several laser systems. These are laser devices from Sciton Medical Inc (California, USA), Fotona (Slovenia), PinPoint (Cynosure, USA), FriendlyLight Neo (Aerolase, USA) and others. Consider the operation of each of the devices and the effectiveness of its use for the treatment of onychomycosis.
Fotona Dynamis SP is a long-pulse neodymium laser whose beam moves in a spiral along the nail plate. The course of treatment consists of 4 sessions, which are held with an interval of 7 days. The essence of the procedure: the laser beam is in contact with the cells of the mycelium of fungi, as a result of which the light energy is transformed into heat, and the temperature in the area of influence rises to 45-53 degrees.
This temperature is sufficient for denaturation of the fungal cell protein. The local temperature is measured by a special device - the FLIR ThermaCAM thermal imager. Due to the fact that the heating of the plate lasts only 15 milliseconds and during this time the skin cells do not have time to react and overheat.
This is the main reason why patients do not need anesthesia: 46% of the subjects did not feel anything at all, and 54% felt only a little warmth. For maximum comfort during the procedures, local cooling with a stream of cold air is used by the German installation Cryo 6.
The results of treatment.
- Procedure portability - 100%
- Side effects - not identified
- Complete cure - 86.2% of cases
In addition, researchers testing this laser device came to the conclusion that the technique is effective only if the nail plate is damaged by dermatophyte fungi. Mold and yeast flora are difficult to treat (only 40% of patients recovered).
Sciton Medical Inc - in the laser system uses a universal nozzle ClearSense, which allows you to control the temperature online. This makes it possible to dose the laser power, which in turn ensures the destruction of fungal colonies, restoration of nails and prevents overheating of the surrounding tissues.
Lasers 870 nm, 930 nm, Nd: YAG 1064 nm, Nd: YAG 1319 nm are used for the treatment. Warming depth - 7 mm. The duration of one session is 15-20 minutes (if all 10 fingers are processed). The number of sessions is determined by a specialist (maybe one is enough).
- No side effects
- 79% recovered by the end of the 3rd month of treatment, 100% recovered by the 12th month (without taking antifungal drugs)
PinPointe FootLaser is a laser system with a unique laser pulse feeding and modulation system. The course of treatment consists of 2 procedures with an interval of 6 weeks. The essence of the procedure: from the proximal edge of the nail to the distal are held passes in the amount determined by the doctor.
The spot diameter is minimal, with one point not superimposed on the other. Each PinPointe FootLaser pulse includes 10 micro pulses. They served only 0.5 seconds. The interval between the micropulses is 0.05 sec, but this time is enough for the heated capillaries under the fungus to cool down and not be able to damage healthy tissue.
The power of each micro-pulse is 20 J / cm2 per 100 ms, or 200 mJ / cm2. Such an impact structure is called stacking.
Treatment conditions: the thickness of the nail plate should not be more than 3 mm, prior cleansing of the nail with keratolytic agents or a pedicure machine.
The results of treatment.
- Complete cure - 81.5%
- No pain effect
- Impulse with modulation prevents burns of tissues surrounding the nail
- Ability to use with "diabetic foot".
Friendly Light is a neodymium laser with a wavelength of 1064 nm on an yttrium-aluminum garnet with 0.65 ms. momentum. The course of treatment is 2-3 procedures with an interval of 3 weeks. The essence of the procedure: each nail, affected by the fungus, is processed by the cross method with two alternating passes of laser pulses (one in the vertical plane, the second - on the surface of the nail horizontally).
On the treatment of one nail in one session takes a maximum of 45 seconds. This time is sufficient for the entry of the laser beam deep into the nail bed and the thermal overheating of fungal matter, which is forced to restrain its growth. Pain due to ultra-high pulse duration does not occur, as however, and healthy areas of the skin are not damaged.
Cooling is not required, but particularly sensitive patients can use ice to cool.
The method is ineffective with uneven nail surface and in cases where the thickness of the damaged nail is uneven.
The results of treatment.
- Significant improvement in the appearance of the nail
- Lack of discomfort.
- During the study, 7 of the 8 patients got rid of the fungus.
The essence of the procedure and its merits
In fungi that are found on human nails, the mycelium (mycelium) has the shape of a stroma. It contains all the fungal spores and nutrients. It is on the mycelium that a high-intensity laser cure is directed. External antimycotic agents are not able to penetrate so deeply (mycelium lies at a depth of 7 mm.), Therefore, treatment by them is often ineffective.
Any laser system works on the same technology: warming up the nail, nail bed and growth zone. Under her influence, mushroom spores stick together and cease to exist.
Specific recommendations on how to prepare for a laser therapy session will be given by the specialist conducting it, because they depend on the apparatus used in the clinic. In general, on the eve of the procedure, it is advisable to hover your feet in a soda-soap bath, cut the nail as much as possible and cut off its surface.
In addition, for 7-10 days you need to stop taking any medications, and 2 days before taking tests for the presence of a fungus, remove the cosmetic varnish from the nail plates. Again, these manipulations are necessary only if the dermatologist has confirmed their necessity.
Experts recommend to irradiate 10 nail plates at once, even in the event of a lesion of one or two.
The unique benefits of laser therapy:
- Lasting therapeutic effect
- Lack of pain or its minimum level
- Laser treatment has a disinfecting effect.
- No side effects
- The course of treatment is short and does not require hospitalization.
- Rehabilitation not required
- Inability of fungal spores to adapt to the laser beam
- The time of exposure of the beam to the nail plate and its power is dosed strictly individually
- Painless procedure (anesthesia is not required)
- Healthy tissue is not damaged
- Lack of intoxication
- Quick effect (first results are noticeable after the first session)
Contraindications and possible complications
Like any other method of treatment, laser therapy has a number of contraindications. These include:
- Any tumors (benign and malignant)
- Coagulopathy (low platelet count)
- Immune system disorders
- Endocrine diseases
- Pregnancy and lactation period
- Increased skin dryness and thinning
- Taking medications that cannot be canceled
- Laser tattoos
- Connective tissue diseases
- Acute inflammatory processes
- Chemical peel produced less than 2 weeks ago
- Solarium or beach visit less than 2 weeks ago
- Infectious diseases
Laser systems are equipped with everything necessary so that side effects are absent. If after the procedure a cuticle burn appeared, the nail plate was deformed or scars appeared, then this is not a result of overheating of the tissues, but an illiterate treatment of a specialist with a laser apparatus.
Continued: laser nail fungus treatment
The efficacy of treatment of onychomycosis of the feet with a laser can be judged only after 6-12 months. That is how much time is required for the growth of a healthy nail plate. The specialist is able to notice the result after the first session, but this requires a microbiological study.