RE: Efficacy of Lasers for Onychomycosis (Tip Sullivan, DPM)
From: Burton J. Katzen, DPM
Congratulations to Dr. Sullivan for being smarter than I am and not purchasing a laser. In all my research looking at numerous lasers and numerous pictures of “before and afters” from various companies, no one ever showed me a completely thick nail getting thin and pink again after using a laser. Every nail I saw was pink and attached at least proximally, which meant to me that if the nail was cut down to the area attached or even removed and treated by other modalities, the desired results could be obtained. That being said, I made the plunge.
I obviously only performed lasers on positive cultures, but I now find myself many months later trying to explain to patients why they spent the money and still have "thick nails." I do follow up all laser treatments with local anti-fungals and periodic grinding down of the nails as they are growing. My weak explanation is that “at least we killed the fungus (the infection), but there was obvious chronic underlying root damage that caused the thickness.”
I must say, however, that my laser website ($250/month) has bought in numerous patients, but I now find myself seeing new patients who are asking for laser treatment and recommending a different mode of therapy for 90% of them. I tell the ones who do opt for laser that we may kill the fungus, but I can't guarantee a pink nail. The good news - only 48 months left on my lease.
Burton J. Katzen, DPM, Temple Hills, MD, DrburtonK@aol.com
