Nail fungus, particularly in the toenails, is a common malady among older persons and laser therapy is being used as a treatment but is it worth it? Dermatologist B.E. Elewski says that merely being over 60 years of age is a risk factor for this type of fungus. It is wise for elderly persons to use effective treatments, including new therapies that appear promising. Is laser therapy for toenail fungus one of the promising treatments?
There are many traditional treatments for nail fungus including oral and topical anti-fungal treatments. (Please see "Treating and Preventing Nail Fungus in the Elderly," Seniorsmatter.com.) In addition, the affected part of a nail or the whole nail plate can be removed surgically and rapidly as an outpatient procedure.
These traditional treatments have potential side effects. Oral medications can cause upset stomachs and even liver damage, according to the Mayo Clinic. They are not always effective in elder persons. Topical ointments may take months to work. Removal of the nail or a portion is painful and takes a long time for growth of the nail. Recurrence and reinfection are common.
Laser treatment of nail fungus, which was approved by the FDA in 2010, penetrates the nail plate and kills fungi underneath. Advocates of laser therapy for toenail fungus say the procedure is fast, painless and brings quick results. But scientists do not agree.
Becker and Bershow reviewed the scientific studies of laser therapy for toenail fungus and found no effective results in randomized, controlled, clinical trials. In addition, the therapy was not painless and recurrence of fungal infection was high.
However, the authors of the literature review acknowledged that reinfection is so common with nail fungus that it is possible that reinfection, not recurrence of the original infection, was responsible for the unpersuasive results.
Another study, published in the Journal of the American Academy of Dermatology, noted that laser treatment did not produce a cure when tested on humans with toenail fungus. The researchers noted that only one kind of laser light was tested. Nevertheless, they stated about their results: "In vivo treatment did not result in onychomycosis cure" meaning that the testing of laser treatment on human patients did not produce a toenail fungus cure.
Another detriment of nail fungus laser therapy is cost. The expense is usually not covered by insurance because toenail fungus is deemed a cosmetic issue, not a serious health matter. Treatment is elective and based more on the appearance of the feet than an actual health threat. The cosmetic side of nail fungus is perturbing to those who have it. Symptoms of nail fungus include distortion of the nail surface, including a brittle or ridged appearance, discoloration of the nail surface (usually a dull yellow color) and brittle-looking or crumbling nails. But it is rarely a dangerous condition.
Until laser therapy passes more randomized, controlled, clinical tests elderly patients may wish to forego the expense. Although laser therapy for nail fungus may be the wave of the future, at this time it has not proven effective. Scientists recommend traditional treatments as they have proven to be more effective.
Becker, C., Bershow, A. (September 14, 2013). Lasers and photodynamic therapy in the treatment of onychomycosis-a review of the literature. Dermatology Online Journal, 19(9): 19611. Available online at http://escholarship.org/uc/item/0js6z1kw. Accessed March 10, 2017.
Carney, C., Cantrell, W., Warner, J., Elewski, B. (October 2013). Treatment of onychomycosis using a submillisecond 1064-nm neodymium:yttrium-aluminum-garnet laser. Journal of the American Academy of Dermatology, 69(4): 578-582. DOI: http://dx.doi.org/10.1016/j.jaad.2013.04.054.
Elewski, B. E. (July 1998). Onychomycosis: Pathogenesis, Diagnosis, and Management. Clinical Microbiology Review, 11(3): 415-429. Available online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC88888/. Accessed February 17, 2017.
Great Neck Family Foot Care. (February 24, 2017). Safe & Effective Laser Treatment for Toenail Fungus. Available online at http://greatneckfamilyfootcare.com/2017/02/safe-effective-laser-treatment-toenail-fungus/. Accessed March 10, 2017.
Mayo Clinic. Nail Fungus. Available online at: http://www.mayoclinic.org/diseases-conditions/nail-fungus/basics/symptoms/con-20019319. Accessed February 17, 2017.
O'Connor, A. (March 14, 2014). Laser Treatments for Toenail Fungus. Ask Well. New York Times. Available online at https://well.blogs.nytimes.com/2014/03/14/ask-well-laser-treatments-for-nail-fungus/?_r=0. Accessed March 10, 2017.