5 Crucial Mistakes to Avoid With Toenail Laser Treatment
Patrick A. DeHeer, DPM
1. Make sure you have Onychomycosis (nail fungus) prior to paying for any laser treatment - There are other conditions that can cause similar nail changes to fungal infections. A simple nail PAS (Periodic Acid Schiff), KOH (Potassium Hydroxide Preparation), or a fungal culture will help to confirm a clinical diagnosis.
a. There is a relative high rate of false negatives with these tests usually due to inadequate specimens.
b. A good specimen is obtained as far back on the nail including the debris beneath the toenail.
c. If a negative result occurs, then a determination must be made based on history and review of systems whether or not to proceed with treatment.
d. Other conditions that resemble Onychomycosis.
ii. Onychodystrophy – a nail injury from either trauma or prior surgery.
iii. Lichin Planus
iv. Eczematous Dermatitides
v. Alopecia Areata
2. Only treating the nails with one laser treatment – It is becoming evident that laser therapy for Onychomycosis requires more than one treatment.
a. It is recommended that each laser session consist of two or three rounds for each infected nail.
b. Typically three to four laser treatments spaced four to six weeks apart are required for best results.
3. Not debriding (cutting the nails as short and as thinned as possible) prior to laser therapy – debulking the nails is very helpful for quicker and better results.
4. Not treating chronic Tinea Pedis (chronic athlete’s foot) which is often the predecessor to Onychomycosis. If fungal elements are left on the skin and the nails are cleared by laser treatments, the skin fungus will more than likely infect the toenails again.
a. Treatment choices for chronic Tinea Pedis –
i. Topical prescription antifungals creams/lotions/gels – must be used for four weeks for a chronic condition.
ii. Oral antifungal pills (Lamisil) – only needs to be taken for four weeks.
1. Liver function tests usually not required if taken less than six weeks.
5. Not controlling Hyperhidrosis (excessive foot sweating) – This will lead to higher recurrence rates. Fungus likes a warm, moist environment; sweaty feet in closed shoes are an ideal condition for fungus to take over and spread. The following breakdown of patients is based on my experience over 20 years.
a. 90% of patients with Hyperhidrosis can be controlled with an antiperspirant spray that you would use under your arms after bathing and drying off. Make sure you use a spray and that it says “Antiperspirant” on the can. Spray the tops and bottoms of the toes, then the sole of the foot. Let things dry for a second and you are done.
b. About 5% of patients with Hyperhidrosis require a prescription drying medication, such as Drysol.
c. About 3% of patients with Hyperhidrosis require either Botox® injections or iontophoresis.
d. About 2% of patients with Hyperhidrosis require an oral medication like Robinul (Glycopyrrolate).
*Bonus Tip – I often use a topical nail antifungal called Formula 3 in between laser treatments. You can also take Lamisil while undergoing laser treatment. Formula 3 is the only oil-based topical antifungal medication; therefore it is able to actually penetrate into the nail unlike a lacquer.
For more information visit - www.IndianaLaserToenailFungus.com
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