Fungal toenails are a common problem in the United States. Common ways of contracting this disorder are by walking barefoot outdoors, in locker rooms, across carpets, sharing infected nail clippers or even shoes. These invisible spores get in under the overhanging edge of the nail and travel from the edge of the nail all the way to the cuticle living within the nail bed.
While about 36 million people in the United States are estimated to have onychomycosis (medical term for fungal nails), only about 6.3 million have had their condition been diagnosed by a physician. Recent statistics show that of the 6.3 million who have been diagnosed, only 2.5 million people per year are actually being treated for this disease. That means there are some 33 million people with this disease who are not being treated.
Toenail fungus may be confused with other nail dystrophies such as traumatic damage, psoriasis, senile ischemia, a tumor of the nail bed, peripheral vascular disease, atopic dermatitis, contact dermatitis, lichen planus, and yellow nail syndrome. While liver disorders such as hypoalbuminemia, cirrhosis, and striate leukonychia can induce whitening of the nails resembling a fungus. This is why it is very important to see a specialist (podiatrist, dermatologist) for proper diagnosing of your nail disorder. Performing a KOH, acid-Schiff stain, or biopsy (best method) can accurately diagnose whether you have a fungal nail or another disorder.
The latest treatment option for nail fungus is laser therapy. There is a major misconception along with false advertising that any type of laser apparatus can be used to treat fungal nails. There are only two companies recognized for its research for laser treatment of fungal nails, Noveon and PathoLase. But neither is FDA approved at this time for treatment of fungal nails.
So, what is the treatment like? This technology works by applying a laser to each toe for up to 10 minutes. It is reported to be pain free, and allows the nail to grow out in six to 12 months without the fungus. But there are several issues with regards to the laser treatment. First, it is not covered by insurance, and can cost over $1,000. Second, it is not FDA approved for toenail fungus. Both lasers available in the United States have been approved for either dental or septal surgery, but not for nail surgery. Third, do you really have fungus? If you have for instance onycholysis (discoloring and separation of the nail due to trauma) the laser will not work. Fourth, you have to treat the cause of the fungus, such as creating a fungal free space by sun exposure and applying antifungal powders to your shoes and feet. Fifth, the studies that show this technology works are small, non-evidence based, non-blinded studies. Sixth, the laser does nothing to prevent re-infection of the nail. Seventh, no data exists to determine which type of fungal spores the laser treats. Currently there are studies underway, but the results will not be available until 2010 at the earliest, so we wait until then for the final verdict.
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