Updated: Aug 13, 2018
Toenail fungus (aka onychomycosis) is the leading cause of nail disease in adults with up to 14% of the North American population being affected (4,5). It often results in the nails becoming thickened, discolored, misshapen, and brittle, and although the fungus itself is not harmful to the body systemically, it can cause added pressure to surrounding skin of the involved toes. There is also a social component to having nail fungus, which can make people feel embarrassed when their toenails are visible.
When it comes to treating toenail fungus, there are many options; however, most require a long treatment period, and none are 100% successful. Topical anti-fungal medications have a difficult time penetrating the nail plate to get underneath it, often where the fungus resides. Oral medication, such as Lamisil, may be the most effective treatment with a 76% cure rate after 12 weeks of treatment, but it has potential side effects and may be harmful to the liver (2). It is also contraindicated in patients who are pregnant or who are taking other certain medications. Keryflex Nail Restoration is a cosmetic procedure for those looking to simply have more normal-looking toenails, but it isn't really meant as monotherapy in the treatment of nail fungus. And then there is laser therapy, which has become a popular treatment option for those who don’t want to be on medication. It often requires multiple treatment sessions spaced apart and is not covered by insurance, so it can become costly. So, before you decide to invest in it, it is important to know how it works, who may benefit from its use, and the chances of it being successful.
How does laser therapy work?
Laser therapy uses light energy to inhibit fungal growth by heating and destroying the tissue that gets absorbed it (1). The FDA has now approved multiple different lasers for the treatment and temporary clearance of the nail plate (3,5). But how successful is laser therapy for toenail fungus?
Defining & determining success with laser therapy for nail fungus
Based on my limited and quick research for this blog, I found success rates for laser therapy in patients with nail fungus to range anywhere from 14%-100% (3,5). That range may be so extreme because it is difficult to determine the overall effectiveness when there are so many different variables being evaluated in these studies, including the specific laser used, the frequency of treatments, the severity of the nail fungus, and the follow-up time period. Having a limited number of participants (many studies under 100), can also easily affect these outcomes. Lastly, the definition of success to a physician may also be different from a patient.
A 2017 study showed significant improvements in fungal clearing of infected toenails, but according to the study’s questionnaire regarding the participants’ quality of life, a significant improvement was not found (5). So, was laser therapy successful here? A number of other studies look at mycology cure instead of just clinical improvements. This may be a better predictor of success if, after treatment, the mycology examination revealed no fungal growth. Unfortunately, study results are inconsistent with this lab test, as well. A recent study out of Brazil revealed positive nail fungus elements in >90% of their participants 12 weeks after their third and final laser treatment, yet, in their article, they sited multiple other articles that claimed to have 100% mycological cure in their study participants (3).
Laser treatment costs
Because laser treatment for nail fungus is currently considered a cosmetic procedure, it is not yet covered under insurance plans. This can make the procedure pricey, especially since multiple treatment sessions are often recommended. The cost for one session may vary depending on which laser is used and how many toenails are treated; however, the bill could run you $1000 or more.
Unfortunately, there is still no perfect method for getting rid of nail fungus. Laser therapy may be a good option if the topical anti-fungal medications don’t work and you cannot take Lamisil. However, with the price of treatment being so costly and the success rates being inconsistent (in many cases less than 50%), it may be more beneficial to do local and routine maintenance on the nails (i.e. trim, file), followed by the Keryflex procedure during the summer months when your toes are more exposed.
DISCLAIMER: The above information is meant for educational purposes only and should not be construed as medical advice. Please consult the doctor, or your own healthcare professional, should you have questions or concerns related to your health.
1. Cole, G.W. Treating Onychomycosis with Laser Light. Retrieved from https://www.medicinenet.com/treating_onychomycosis_with_laser_light/views.htmon July 11, 2018.
2. Darkes, M. J., Scott, L. J., & Goa, K. L. (2003). Terbinafine. American journal of clinical dermatology, 4(1), 39-65.
3. Do Espírito-Santo, G. A., Leite Jr, D. P., Hoffmann-Santos, H. D., Dias, L. B., & Hahn, R. C. (2017). 1340nm LASER THERAPY FOR ONYCHOMYCOSIS: Negative Results of Prospective Treatment of 72 Toenails and a Literature Review. The Journal of clinical and aesthetic dermatology, 10(8), 56.
4. Ghannoum, M., & Isham, N. (2014). Fungal nail infections (onychomycosis): a never-ending story?. PLoS pathogens, 10(6), e1004105.
5. Johnson, R. E. (2017). Clinical clearing of moderate and severe onychomycosis with the Nd: YAG 1064nm laser and post treatment prevention with tolnaftate.