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Onychomycosis - The fungal Toenail

 
 
The most common cause of brittle yellowing nails is fungal infection.  Millions of Canadians are infected with dermatophytes, non-dermatophytes and candida species feeding on the nail keratin.  These organisms propagate in a warm, dark and moist environment.  There is no better place for nail fungus to reside and infect toes than in shoes.  Infected nails have yellowing or white spots on the nails.  The large toenail is usually the first to be effected.  As the infection develops, nails often become thicker, further discolor, fracture, and crumble.  Progressive infection of other nails occurs often, secondary bacterial infections are not uncommon, and psychosocial issues.
 

The ability of the 1064 nm  laser energy, without anesthetic, to gently heat the nail bed, makes it ideal for safe and effective clearing of the nail bed of fungi.  The photo-thermal effect changes cellular metabolism and at increased temperatures cell components are damaged and metabolism is altered.  Lipids in the cell membranes are changed in structure, compromising their function of protecting and regulating the internal environment.  The outcome is fungal death and nail clearance.
 
As is seen with the common oral anti-fungals (Terbinafine, Itraconazole and Fluconazole) the re-occurrence rate can be extremely high.  Topical anti-fungal liquids may help to alter this observation.  The laser is similiar in efficacy to these oral antibiotics (pills) which are taken over a course of 3 to 4 months or longer.
 

Do I need a podiatry visit?

 
Probably most people with fungal nail problems have tried topical and other home remedies at one time or another.  At this time there is only one Health Canada approved topical medication for onychomycosis called Penlac.  Yes, it's very safe however it's efficacy is terribly low (less than 5% to 20%).  Melaluca (tea tree oil) is another popular home remedy,  and again, without evidence in main stream medicine to support it's value as an anti-fungal for infected nails.
 
Laser treatment is the up and coming standard for fungal nail infections in terms of both medical saftey and sucessful outcome!  One must also be aware that there are many different types of lasers, each class developed and geared towards a specific application.  For fungal nails a YAG laser at a wavelength of 1064 nm, seems to be ideal.  The patient should ensure the equipment is Health Canada Approved for treatment of fungal nails.