Groupon was recently offering laser treatment of toenail fungal infections for $199. Is this a deal (in some clinics treatment can be $600 to $1000) or stealing your money for a therapy unlikely to work?
Fungal infection of the toenail (onychomycosis) is a difficult to treat condition. The infection causes discolored, bumpy, ugly toe nails that can be hard to cut. The treatment is challenging because the beasties live in the nail bed (the part that we can’t see, beneath the skin). Topical therapies are largely ineffective because they don’t penetrate into the nail bed. The standard treatment is oral anti-fungal medications. The oral medication makes it to the nail bed by traveling through the blood stream, but the down side is the medications have to be taken for 3-9 months. The success rates range from 30-90% depending on the severity of the infection and the medication. High-dose fluconazole (450 mg) taken one a week for 12 weeks seems to have the best success rate (90% cure). Some treatment regimens require blood monitoring and all anti-fungal medications have drug interactions to consider.
So, given the option of taking a prescription medication for months (that might not work in the long run) and the prospect of blood monitoring and potential medication interactions, it’s no wonder people are intrigued by the idea of a laser, especially when accompanied by:
95% effective! Painless! 10 minutes!
The studies with lasers are sparse: 2 published in the world literature as of January 2012. These studies are also small (one study with eight patients and the other with 26 toes!), so that’s not generally an encouraging sign. Another unpublished study, but presented at a meeting, evaluated 39 toenails. These three studies only had short-term follow-up, so while there was “improvement” (meaning 3-4 mm of clear toe nail growth) for 63-85% of toenails at six months and one study reporting a 50% “cure” rate after four treatments with the Noveon laser (the other laser used is the PathoLase PinPointe FootLaser), no study reported on long-term outcome. No study compared laser to the standard oral medications or provided data on long-term safety (the biggest safety concern is damage to the nail bed with temporary or even permanent loss of the nail).
With small studies that are in reality just case series (read: weak studies from which we can draw no conclusions, although they may indicate that further well-designed large studies may be indicated), no long-term data on outcome, and no safety data it’s no wonder that neither laser is FDA-approved for this indication.
So, laser for toenail fungus could be cool cutting-edge therapy, the same outcome as oral medications, a total bust, or even damaging to the toe nail. No way to tell. It’s a total gamble.
But say this is the kind of gamble for you. What else should you consider before taking the leap?
With any “new” medical therapy (really, with any therapy) it’s best to go to an expert. For toenail fungus that’s typically a family physician, a dermatologist or a podiatrist (foot doctor). That way you can get a correct diagnosis and hear about all your options before proceeding with the laser treatment.
Many medi-spas say they are affiliated or helmed by a board-certified doctor, but if the web site doesn’t list the doctor’s name and their specific speciality certification, well, the doctor could be board-certified in ophthalmology or gynecology (would you let a plumber fix the wiring in your house?). And they may really be a doctor, but what if they trained in an off shore diploma factory? Would these things matter to you?
What success rate is quoted? If they’re throwing around over 90% effective! well, there are just no studies (as of January 2012) to back up that kind of claim so it’s hard to call it, um, the truth. Another huge red flag is failing to mention complications. Nothing is too good to be true and nothing is risk free.
My final take is if lasers were really over 90% effective! and risk free! then insurers would probably cover the therapy, and they aren’t. Conventional therapy isn’t cheap. Also, if the results are that amazing, one would think the laser companies would get a few more studies out there. But I never understand Big Pharma, and if they’re already getting people to use the therapy with the paucity of data that exists, well, why make the investment?
And that’s the state of the evidence on laser therapy for onychomycosis.
For more information on treating toenail fungal infections click here