03/26/2014    Keith Sklar, DPM

Has Laser Nail Fungus Removal Been Proven Effective? (Leonard A. Levy, DPM MPH)

The question asked, “Has Laser Nail Fungus Removal
Been Proven Effective?” I think this is a
confusing question. The question should be, “Does
the Laser play an effective part in clearing
dystrophic nails?” In my experience, the answer is
a definitive YES. I have treated hundreds of
patients with my laser and have achieved
impressive results.

In a previous post, I shared my experience on the
treatment of dystrophic nails. The laser is only a
part of my treatment plan to clear and maintain a
healthier nail plate. My treatment plan includes
the following: (1) Laser treatment, (2) Educating
the patient on fungal prevention and how to reduce
risk of reinfection, (3) Application of topical
anti-fungals, and (4) Possible use of oral anti-
fungals.

It seems that the laser gets a bad rap, however,
if used properly it’s a very effective tool. It’s
only effective though if the doctor providing the
care is passionate and thorough, which I am. My
treatment protocol and my findings have
consistently shown results you can see. I’ve
posted these results on my website.

Podiatric pathologies (bunions, heel pain, warts,
etc.) are not cured in one visit or by one
treatment application. All pathologies require a
treatment plan. So why do you expect the use of a
laser for the treatment of onychomycosis to be so
immediate and perfect? As I stated on a previous
post, it took me 20 years to become a good
podiatrist. How can someone expect to be great
with a laser within his or her first year? It
takes roughly a year to see your first results.
It will then take another 2 to 3 years to modify
your treatment protocol, and then a few more to
perfect them.

Keith Sklar, DPM, Schaumburg, IL,
keithsklar@footfirst.com

Other messages in this thread:

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03/28/2014    Bryan C. Markinson, DPM

Has Laser Nail Fungus Removal Been Proven Effective? (Leonard A. Levy, DPM MPH)

The interesting thread in all of the responses to
Dr. Levy's original query is that podiatry does
not demand data when it comes to this treatment. I
was present when Dr. Elewski delivered her results
of an ND Yag laser treatment for onychomycosis
(the study cited in the Times) and have discussed
it with her personally over the past two years at
the Council for Nail Disorders Meeting.

In a nutshell, this is what Dr. Elewski's study
documented: It takes 50 degrees centigrade to kill
dermatophytes. Human subjects in her study could
not tolerate anything over 41 degrees. Her
conclusion was that the laser therefore was not
killing the fungus. She reiterated this at this
year's meeting last week in a comment regarding
another presentation on the subject. This was
about a specific ND Yag wavelength laser, and not
all lasers.

The second part of the problem is the initial
marketing of laser therapy to the public by the
podiatry profession, unchecked by the
manufacturers who claimed they could not control
what podiatrists advertise. Simply stated, for the
vast majority of the plethora of radio and print
advertising for the technology , the public could
not come away with any other impression that laser
was a one treatment ZAP cure forever. This is what
may just have killed the technology for this
indication. Add in the amount of podiatrists who
beleive they don't need confirmatory lab tests to
document the infection, and you have the perfect
storm for labeling the technology as a failure.

I encourage all podiatrists to look at the data on
non-thermal laser therapy for onychomycosis, for
which the Noveon has published peer reviewed data
which Dr. Levy asked for.

Disclosure: I am a consultant to Nomir Medical,
maker's of the Noveon.

Bryan C. Markinson, DPM, NY, NY,
bryan.markinson@mountsinai.org