05/05/2019    Richard Silverstein, DPM

RE: Laser Treatment Reported Ineffective for Onychomycosis Related to Diabetes (Adam Landsman, DPM, PhD)

I whole heartedly agree that we must be very
careful when treating onychomycosis with lasers.
If there is an active tinea infection it must be
treated along with the onychomycosis, if optimal
results are desired. Culture results
demonstrating the presence of a fungal infection
is always an appropriate step prior to initiating
therapy.

Why is it we must be on guard especially in our
diabetic and vascularly compromised patients? I
presume it is to prevent a burn from the heat
build-up of a thermal laser. Our diabetics who
may have neuropathy may not be able to tell us
that something hurts when heat is generated
within the nail plate or nail bed. We also don’t
want to cause a burn in patients whose
circulation is less than adequate to heal a
thermal injury.

This is the crux of my issue when the term
“laser” is tossed about. Not all lasers produce
heat. If the FDA is using this term, it should
responsibly be preceded by “thermal" or "non-
thermal". There is absolutely no contraindication
in diabetics or PAD patients to use an automated,
non-thermal, FDA cleared laser for onychomycosis
(The Lunula Laser).

In the thousands of patients that have been
treated with the only low level, non-thermal
laser (510 K cleared by the FDA) with a
wavelength of 405 nm and 635 nm there has never
been any adverse event reported.

In fact, due to the nature of the mechanism of
action of low level lasers, photobiomodulation,
there is a sustained hyperemic effect which
stimulates the bodies immune system to help fight
the fungal infection. This has been confirmed
with ultrasound.

One size never fits all when tailoring a
treatment protocol for a patient. Some do not
want to be placed on medication no matter how
safe it is. Others want to try everything at
once: creams, pills and non-thermal laser
included. And yet others come in asking for non-
thermal laser therapy, specifically. Our job is
to provide the relevant information so an
educated decision can be made by the patient.

Disclosure: I am a consultant for the Erchonia
Laser Corporation

Richard Silverstein, DPM, Havre de Grace, MD

There are no more messages in this thread.