Nail care Center of Podiatry Associates of Virginia PODIATRY ASSOCIATES OF VIRGINIA
          Virginia Beach Location                                                                                                  Norfolk Location
           936 General Booth Blvd.                               757-228-1980                         902 Graydon Avenue
         Virginia Beach, Virginia 23451                                                                                  Norfolk, Virginia 23507
PODIATRY ASSOCIATES OF VIRGINIA

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Onychomycosis

                  More on Laser nail care
                 

FOX 1064 Laser for Onychomycosis*

The most common cause of brittle yellowing nails is fungal infection. Over 35 million Americans have fungal nail infections. Fungi are dermatophytes that feed on nail keratin. These organisms propagate in a warm, dark and moist environment. There is no better place for nail fungus to reside and infect toes than in shoes. Infected nails have yellowing or white spots on the nails. As the infection develops, nails will get thicker, further discolor and fracture. Progressive infection of additional nails is common.

  • Thickening of the nail
  • Build-up of debris under the nail
  • Changes in texture, loss of shine and clarity
  • Brittleness and crumbling at the edges of the nail
  • Small separations of the nail plate from the nail bed

Traditional Treatments

There are several treatments for nail fungus (onychomycosis). The most conservative is to just thin down the nail every 9 weeks and apply topical medications but this type of medicine does not work well if the whole nail is involved. Oral medications (Lamasil) can be prescribed but elevates liver enzymes and can cause liver damage. Women are warned not to take oral medications if they are going to become pregnant.

Laser Treatment of Nail Fungus

The use of laser in podiatry is not new. For years lasers have been used safely on the foot for several conditions. Although the laser is FDA approved for the temporary clearing of nails, new lasers are now being used to treat nail fungus. These lasers have some advantages and are approved by the FDA for many other treatments but laser treatment of nail fungus is considered an "off label use".

The ability of the 1064 laser energy to gently heat the nail bed makes it ideal for the safe and effective desired result of nail clearing. The effects of laser energy on nail fungi are two fold and understood in relation to cellular chemical reactions within fungal cells that are necessary for fungal growth and survival. The photo-thermal effect changes cellular metabolism and at increased temperature (42°C), cell components are damaged and metabolism is altered. The full effect of laser energy is not fully understood but there is thought to be a photo-chemical effect that further compromises fungal cell enzymes and proteins. Lipids in cell membranes are changed in structure and their function of protecting and regulating the internal environment of the cell becomes further compromised resulting in fungal death and nail clearance.

Laser is an excellent choice for patients who do not want to risk taking oral medications.

The following picture shows a nail being treated by the laser:

                             * FDA approval pending for nail clearance

Clinical Results for Nail Clearance with FOX Podiatry Laser

A single center non-randomized clinical investigation was conducted to evaluate the safety and efficacy of the Fox Diode Podiatry Laser when used to promote the growth of clear nails in patients with onychomycosis affecting the hallux (big toe) of one or both feet. Patients were first evaluated to confirm a diagnosis of onychomycosis by either a positive Periodic Acid-Schiff (PAS) stain or clinical appearance. Each patient was informed of the nature of the procedure including a requirement that they return for a follow-up office evaluation or participate in a telephone interview approximately 2 months after treatment to assess the effectiveness of the treatment of nail fungus in the treated hallux. A total of 12 patients (8 women and 4 men - 18 to 76 years of age) enrolled in the study which was conducted between February 1, 2011 and July 30, 2011.

Laser therapy was performed using the FOX Podiatry Laser delivered through a hand piece that focused a one millimeter diameter spot on the treatment site. Treatment was applied using a grid-like pattern of the laser across the nail plate starting at the cuticle and moving outward toward the distal end of the toenail. Fluence during the treatment ranged from 25-35 J/cm2 and was variable due a natural variance in the size of each toenail receiving treatment. The pulse duration was 200 ms with a duty cycle of 50% at a frequency of 5 Hz. Mild to moderate heat sensation was reported by the patients and resulted in minimal discomfort and no complications. Improvement in clear nail growth was reported during the patient follow-up office visit or by means of a telephone interview the patient’s perception of improvement to the fungus infection of the treated toenail. The results of the clinical study are summarized in the following table.

Patient Demographics and Two Month Results Following Laser Treatment

Patient

Age

Sex

Hallux

Treated

Diagnosis

No. of Treatments

Clear Nail Growth

1

57

F

R,L

+PAS

1

Yes

2

55

F

R,L

+PAS

2

No

3

22

F

L

+PAS

1

Yes

4

73

F

R,L

+PAS

1

Yes

5

23

M

R,L

+PAS

1

Yes

6

49

M

R,L

+PAS

1

Yes

7

18

F

R,L

+PAS

1

Yes

8

65

M

R,L

+PAS

1

Yes

9

31

F

R,L

C

1

Yes

10

63

F

R,L

C

1

Yes

11

76

M

R

+PAS

2

No

12

33

F

R,L

+PAS

1

Yes

R = Right foot    L = Left foot   + PAS = Periodic Acid-Schiff Stain Positive    C = Clinical Appearance

Clearing of the proximal nail was observed in 10 (83%) of the 12 patients participating in the study. The two patients who did not show improvement at the end of the 2 months underwent a second treatment which was also not successful in promoting the growth of clear nail. Mild to moderate heat sensation was reported by the patients and other than that transient discomfort the side effects of treatment were minimal. The patients reported satisfaction in the treatment outcome. This clinical trial demonstrated that the FOX Podiatry Laser when used in a clinical practice to treat patients with onychomycosis is safe and effective.

At the time of this posting Podiatry Associates of Virginia is the only Medical office who has the Fox Laser in Hampton Roads              


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