Lasers for Toenail Fungus – What they Don’t Tell You

If you have toenail fungus, and you are reading this you have probably seen a lot of information on using lasers to treat the problem. Unfortunately, there is some misinformation and some confusing claims being made about these treatments.

There are two companies with lasers to treat fungal toenails. Neither laser has FDA approval for this purpose – they are both being used “off label.”

Since the procedures are not FDA approved, insurance companies will not pay for the treatments. You will pay between $600 for one foot to over $1500 for two feet for one treatment. You may need more than one treatment – and there is nothing to prevent you from getting the fungal infection again!

As I tell my patients, “fungus loves dark, warm and moist areas – like your shoes!” That’s why just because you have had a laser treatment doesn’t mean you won’t get the fungus again.

Cost – this a real issue with me. The oral medication (Terbinofine) is really quite safe and has an effectiveness of up to about 70% (laser treatment claims 88%). But the thing is the pill is VERY cheap. You can complete the three months of one pill a day treatment for a grand total of $12 at Walmart.

Of course with a greater success rate and no potential side effects to worry about the laser is terrifically exciting!

I love lasers! I have used the carbon dioxide laser for ingrown toenails for over 20 years and have served on Seton Hospital’s Laser Committee. Lasers are a fantastic tool that allows doctors to work with greater precision and provides better outcomes for patients. The thing is, when I use the laser for ingrown toenail procedures I do not charge one penny for the use of the laser. A laser is a tool I use to provide better service to my patients.

I am very interested in the lasers for fungal toenails. Here’s what I’ve found so far:

The Pinpointe laser came to market first, and I am somewhat skeptical of the claims they make of being able to cure fungus in toenails. I have not seen good data that supports the claims that this unit can cure fungal toenails. The Pinpointe laser uses high energy radiation. There is a potential of burns to surrounding tissue. Due to the lack of data showing it’s effectiveness and the high cost associated with treatment, I am advising my patients to avoid this treatment for now.

I am more impressed with the Neovon laser by Nomir Medical Technologies, unlike Patholase, Nomir is waiting for FDA approval before bringing their laser to the market. I am also more impressed with the studies that have so far been released. Based on the data released so far, the Neovon laser appears to be more effective. The Noveon uses two wavelengths of low energy near-infrared beams that eradicate the fungus in the toenail by using light rather than heat as with the Pinpointe laser. This prevents damage to the surrounding tissue. This should allow for more effective treatment of nail fungus with better outcomes and less chance of complication. Light energy is used to kill the nail fungus without creating damaging heat.

Both the Pinpoint laser and the Nomir lasers are expensive to purchase and to use. I am currently looking at a third company that has a laser with the two wavelengths of the Noveon laser. The advantage would be a much lower cost of treatment.
If you have toenail fungus, you can see exciting things are happening to treat it. From my 20 plus years of laser experience I expect this market to shake out very soon. Right now we are treating fungus toenails by professionally “debriding” the nail – (making it look much better), using an effective topical medication, and in selective cases using the inexpensive oral medication.

I remember when I was on the hospital laser committee we recommended that the hospital delay the purchase of a new type of eye laser. It was a good thing because six months later the second generation of that type of laser came out that was a quantum advance in safety and effectiveness – at half the cost!

We just may have the same situation with lasers for fungus toenails.

I may be evaluating a dual wavelength laser and needing volunteers. My philosophy is to do all the safe, simple topical treatments and add the laser to those treatments. If you are interested in participating in a study of this type of treatment please contact my office for the details.

Note (10/2012):  For more updated information on laser treatment of toenail fungus, check our blog entry “The Latest Thinking on Toenail Fungus.”