To ask your question, go to the bottom of this page and leave a reply to this blog.
Laser therapy is our preferred treatment for toenail fungus and we use lasers to treat patients with toenail fungus in our Seattle foot and ankle clinic. There is, however, a lot of information on the web about laser treatment for fungal nails that is misleading and some of it is patently false. We have researched this treatment in great depth and established a regularly updated webpage to provide consumers with information about laser treatment for nail fungus.
We are podiatrists practicing in Seattle. We do provide laser treatment for our patients, but we are very careful to give patients a realistic idea of what to expect from laser treatment.
This blog entry is designed to give you a chance to ask any questions you might have about laser therapy for nail fungus. To ask your question, simply go to the bottom of this page and leave a reply to this blog. First, however, read our latest update on lasers for fungal nails. You will likely find the answer to your question there.
If not, go to the bottom of this page and leave a reply to this blog to ask your question. We will answer questions via the blog a couple times per week.
We look forward to hearing from you,
Larry Huppin, DPM Doug Hale, DPM
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What causes one’s nail to fall off and is there any special treatment when it does? Will the fungus regrow? Thank you. Carmel Pope
There are a lot of reasons for a nail to fall off. Two of the most common are trauma and a fungal infection. If there is a fungal infection present, the nail falling off will not affect the presence of fungus. The fungus would still be there. I recommend seeing a podiatrist for an evaluation.
What is the minimum age for laser nail treatment and does it hurt?
There is no minimum age. It doesn’t hurt. The toe gets a bit warm but usually there is no pain.
One thing to keep in mind is that while topical medications tend not to work very well on adults they do sometimes work on kids. Have the nails checked out by a podiatrist or dermatologist.
Any hope on the horizon for fingernails? I have one affected that I haven’t been able to treat pharmaceutically for 2 1/2 years due to pregnancy and now breastfeeding (and am not keen on the drugs anyway). Seems the practitioners doing laser are podiatrists and won’t touch my fingernail. The longer I wait, the more discouraged I get–and the more embedded the fungus becomes. 🙁
Hi Caren,
I’m sure there are some dermatologists that also have the lasers, but the fact is that none of the lasers have been proven to work to treat fungus on any kind of nail – toe or finger. There may be new research coming soon, but the lasers that are currently on the market (Pinpointe, CoolTouch and Cutera) have no ongoing studies that I can find. The only one with any decent evidence it works is the Noveon laser – and that is not on the market yet. I understand how tempting it is, but for now, it is very likely you would be throwing your money away to spend it on laser treatment of the fungal nails. Don’t fall for the advertising – much of it is false. Best of luck.
I’m wondering about toenails that have stopped growing. I have 2 that I’ve been almost in tears trying to treat for a long time now and bought some of your recommended products to do so. Any other suggestions. Dissapointing to hear the laser treatments may not be effective since I thought it was my answer! All the podiatrists in my area (Northern NJ) are advertising like crazy about the lasers.
Hi Kelly,
It would probably be worth it to have the nail tested to see if there is fungus present. You can’t really tell if fungus is present by looking at the nail. The only way to know for sure is to get a lab test done that determines if fungus is present. At this point I would go see a podiatrist who is NOT advertising the laser unless they are being very honest about the current lack of data to support the use of the lasers.
If there is fungus present, then treating the fungus may result in your nail growing again. Currently, the oral anti-fungal medications have been shown in studies to be most effective treatment for nail fungus. Most studies show between 60% and 75% success. This is far better than the current studies on lasers (don’t believe the “85% success rate” being advertised for laser treatment. That number comes from a very small and poorly done study). The stuff on our website seems to work as well as any of the topical medications, but not nearly as well as the oral medications.
Now, if the test of your nail shows no fungus present, then none of the fungal treatments are going to work. Then you might want to talk to a podiatrist about nail restoration. Some podiatrists are using a “nail restoration system” where they grind off the old nail and then place an artificial toenail on the toe. One system is called Keryflex. Use the link to take a look
There might be studies in the future to support the use of the lasers, but for now we think you would be throwing your money away. We’ll send out an email whenever new information is available. Best of luck
Should one be particularly concerned about having a persistent toenail fungus when one is anticipating bunion surgery? Does it increase the risk of surgical infection?
Thanks –
Ruth
We know of no evidence that a fungal infection of the nail would increase risk of an infection post bunion surgery. We cannot, however, offer any medical advice. This is a question that should be discussed with your surgeon.
After getting a pedicure I asked the person what was that white spot on my toenail and she said it was a fungus. That scared me but she told me to get Fungi Cure Anti-Fungal Liquid she did not suggest this particular one but she suggested going to the drug store and get something. She said at this point I do not need to see a doctor. It has dried skin around my toe. I have polish on my nail so I cannot see if the spot has gone. When do I stop using this medicine?
We cannot offer individual medical advice, but here is some general information.
First, pedicurists have absolutely no ability to make a diagnosis of a fungal infection. You would get just as good information asking your mailman. There are many causes of “white spots” on toenails and fungus can only be definitively diagnosed by lab tests.
Before using any medication, see a podiatrist or dermatologist and get a diagnosis.
IT does not sound as though laser is very effective yet, however I have only 2 toenails that are affected.. do you thing it would be worth it to try it anyway??.. I have money I need to use or lose in my tax free spending account!.. thanks
It doesn’t matter whether a person has fungus infecting two nails or ten – there is still no valid research showing the the lasers currently on the market work to treat toenail fungus.
The article about Noveon in the NY Times last year said FDA approval was expected in the fall of 2009. It’s fall of 2010 now, and still no approval? Is there any word as to why it’s taking so long, and if Noveon might be a dead product?
I spoke with Dr. Eric Bornstein, the chief scientific officer at Nomir, last month. It looks like they are slowing rolling out the Noveon Laser now. There are a few practices on the east coast that have the unit and are using it. To their credit, they are not marketing the unit until they achieve FDA approval. It seems it is taking a long time because they are doing things right and not rushing an unproven product to market. Nomir has good 6 month data on their laser and we are offering a qualified recommendation. We would like to see a full 12 months of data published before we make a full recommendation.
So far the other companies who are marketing lasers (Pinpointe, CoolBreeze, etc) have absolutely no proof that they are effective for this problem. Our opinion is that you are throwing away money by paying for treatment with these lasers.
I was told by a nurse that taking probiotics will help cure toenail fungus. Is this correct? Does the use of other supplements or overall health affect toenail fungus?
Thank you. Your treatment program is very informative and helpful.
Hi Lisa,
I just did a search of the medical literature and, as expected, there is absolutely no evidence that we can find that supports the use of probiotics in treatment of nail fungus.
In addition, I think the only people who support the use of supplements in the treatment of nail fungus are the people selling supplements. Most supplement claims are false and void of any valid scientific evidence. Don’t waste your money.
With the Noveon laser on the horizon I feel like I should wait instead of six months of cutting, filing, applying toxic creams, etc. What do you think? Thanks!
Not sure the creams are toxic. Keep in mind that although Noveon is the only laser company with believable research, they still don’t have any evidence that they work better than oral Lamisil tablets. I like Noveon and respect the company, but I’m still not ready to recommend them. I want to see at least 12 months of data published before doing so.
How come your website DOES NOT state that the Pinpoint by Patholase received FDA clearance for treating toe nail fungus about 6 weeks ago? I understand that Nomir is having extreme financial difficulty. As you know they began selling there units this past August.
Do you have any opinion on the K-Laser for toe nail fungus. This unit is being heavily marketed in New Jersey, Pennsylvania and Delaware. United Shockwave is suppose to be marketing the K-Laser for toe nail fungus thru out the rest of the country. Do you for see the Cool Touch receiving FDA clearance for toe nail fungus as did the Pinpoint any time soon.
By the way, K-Laser USA has absolutely NO STUDIES at all for the use of their laser for toe nail fungus, however DPM’s are buying the unit in NJ, PA, and Delaware and marketing it to treat toe nail fungus.
Thank You,
Gary H.
Our website DOES NOT (your capitals) state that Pinpointe received FDA clearance because FDA clearance is meaningless. FDA clearance simply means the unit is safe to use on humans. It does not in any way indicate that the Pinpointe laser is effective at treating onychomycosis (nail fungus). We still can find no peer reviewed articles demonstrating that the Pinpointe laser is effective at treating nail fungus and we still recommend that people save their money and avoid this treatment unless some proof of effectiveness can be provided. Same thing for the K-laser. Like Pinpointe, there is no convincing evidence that this laser is effective at treating nail fungus.
Don’t let marketing confuse you. FDA clearance and FDA approval are very different. FDA clearance says absolutely nothing about whether a treatment is effective.
Now I do have a more accurate understanding. Thank you for clarifying this for me.
My doctor said that Lamasil can cause liver failure and would not prescribe it, yet I know several people who have taken it with no problem. What are your thoughts on it? Also, when do you expect to see 12 months of research on Noveon?
Overall Lamisil has a very good safety profile for those with no liver problems, but it is cleared from your body via the liver and is not a good choice for those with liver problems. This is an issue you can only decide with your doctor. You can always get a second opinion.
Thank you. When do you expect to see 12 months of research on Noveon?
Before just reading the notes here, I was on the verge of essentially duplicating Gary H’s Dec 7th question regarding your failing to mention or address the Oct 15th, 2010 FDA clearance of the PinPointe laser…but given your reply, will speak to that instead. 🙂
You answered: >>> (We do not) state that PinPointe received FDA clearance because FDA clearance is meaningless. FDA clearance simply means the unit is safe to use on humans. It does not in any way indicate that the Pinpointe laser is effective at treating onychomycosis (nail fungus). <<<
First, while I understand both Pinpointe's inability to even claim much less prove a "cure" – given that killing the varmints says nothing about preventing reinfection – as well as FDA's typical bureaucratic SYA reluctance to speak plainly, IMO, their clearance does indeed say SOMETHING (contrary to your unequivocal denial above) about the efficacy of the PinPointe laser treatment:
FDA's Clearance (see https://www.accessdata.fda.gov/cdrh_docs/pdf9/K093545.pdf): "We have…determined the device is substantially equivalent…for the indications for use stated in the enclosure (***) to legally marketed predicate devices…"
*** excerpts from the enclosure: "The PinPointeTm FootLaserTm is indicated for use for the temporary increase of clear nail in patients with onychomycosis…" "Clinical study demonstrated the safety and effectiveness of the PinPointeTm FootLaserTm for use for the temporary increase of clear nail at 6 and 12 months following treatment in patients with onychomycosis"
As I read it, FDA's statement, along with their definition of "predicate devices" plus being umbilically joined to PinPointe's proposal claims without caveat or exception, IS essentially accepting the claimed, albeit mealymouthed, efficacy of PinPointe's laser treatment approach!
But whether you agree with me or not, by simply ignoring FDA's acceptance in your main and "latest update" pages, plus discounting it in these blogs which most folks won't take time to read, you risk incurring loss of both objectivity and credibility in your assessments.
For my own long suffering lay opinion having wasted many years and $$$ trying every snakeoil and homeopathic treatment known to man – with many "guaranteed" by hucksters and DPM's alike – as an engineer, I LIKE the notion of using laser technology to positively kill the existing bugs, and fully accept that it's MY responsibility to prevent reinfection post-treatment. Wish me success!
Thanks for your well researched post. This is addressed in our recent update on our nail fungus page.
Best of luck in your treatment – but don’t get your hopes up.
http://www.footankle.com/toenail-fungus-laser.htm
The latest issue of your newsletter of February 27, 2011 states that currently, there is no laser treatment (FDA approved) for nail fungus.
However, there is website shinytoes.com, which offers Cold Laser, FDA approved, for treating nail fungus.
Would you please comment treatment and information provided by shinytoes.com?
Thanks for consideration,
Ivana
Ivana, The Klaser web site does NOT mention anything about treating fungal toenails. http://www.k-laserusa.com. May be FDA approved for use on humans but their own site does not even mention fungal toenail treatment.
There is absolutely no evidence that the laser used by Shiny Toes has any effect whatsoever on toenail fungus. Their laser is NOT FDA approved for toenail fungus, although the laser may be FDA approved for use on humans. Their website is very misleading about this. It seems to us that the only people benefiting from this laser are those charging $500 for what appears to be a useless treatment. Don’t waste your money.
I would like to volunteer for a Nomir clinical trial. Can you refer me as to how to apply?
I would check the Nomir website. Just google Nomir Medical Technologies.
I have an 11 year old son with completely flat feet (also wide feet). His ankles are now “turning in” as well. He loves to play sports, but we noticed that he really began to have trouble with basketball this year. His running became a shuffle, and his feet would hurt afterwards. We have been trying to do some of the recommended therapy, but I wanted to know what else I need to do for him. I thought we would try the OTC orthotics first, but should I go ahead and see about custom orthotics? My only concern about this is how fast his feet seem to be growing. I would be constantly replacing the orthotics. Basically, I would like to know if there is anything specific that I can do for him here at home? I want to do all I can for him. Thanks so much.
Is the Noveon Laser available anywhere in Europe currently for toenail fungal treatment?
I’m not sure. I would suggest checking the Noveon website at http://www.nomirmedicaltechnologies.com
I’ve had the toenail fungus for many years. Are there any published adverse health effects from toe nail fungus that might affect my overall health? Nothing I have ever tried has even remotely begun to cure the fungus including your treatments on the web site. I’m worried about it eventually spreading to my fingers and/or spreading it to my wife. Can direct contact spread the fungus? I have extremely small nails. Would you recommend total removal of the nails and would the fungus still persist without the nails.
Thanks much for the great blog site.
It is not likely to spread to fingernails because fingers don’t live in the warm moist shoes that fungus loves. It can spread to other people but there seems to be a genetic predisposition to it. So your wife may not be prone to it. The only treatment that has greater than a 50% success rate is the oral medication Lamisil. Removing the nail is an option and though I don’t think it would persist after removal, I have never read a study addresssing that so I can’t say for sure.
Do you have tips for me as I have almost gotten rid of fungal nail problems multiple times, only to have them return. I’ve spent a year using tea tree oil with success and then another year doing the same. It always seems to come back. Could it be socks or shoes? Any ideas will be appreciated!
Would you recommend any podiatrist in Vancouver, BC, who is knowledgable about nail fungus? I tried a couple of podiatrists and all they suggest is oral medications and are not even willing to discuss any other options.
The problem is that, realistically, the only treatment that has been shown to have better than a 50% chance of success are the oral treatments. Topical treatments only work 20-30% of the time at best. There is no compelling evidence that the laser treatments work. So it sounds to me as if the podiatrists you have spoken with have given you good information.
If you want to try topical treatments, here is our home treatment plan for fungal nails. Again, however, don’t expect more than a 30% chance of success. And here are instructions on how to trim or thin thick fungal nails.
I don’t know of anyone in Vancouver who specializes in fungal nails. We would recommend from staying away from those selling expensive and ineffective laser nail treatment.
Just read in Google News that Cutera has received FDA approval for its GenesisPlus laser to treat onychomycosis, among other conditions.
They have received clearance to use the unit on treatment of fungal nails in humans (meaning that it is safe to use), but still have no evidence that it works to treat the problem. We would love to say that this treatment works, but unfortunately, there just is not enough evidence. Save your money. Our opinion is that the lasers are mostly a money making scheme.
My doctor had a nail fragment tested and confirmed that there is a fungal infection. He agrees with you that there is nothing on the market now that is encouraging and that once an infection is established in the nail bed, you pretty much have had it. But he did enclose a prescription for Naftin cream with a coupon for a $100 discount from the incredible $260 for the 90g tube. So what is Naftin and is it worth the $160 I would have to shell out?
I don’t think it is worth the money over the other less expensive topical anti-fungals. None of the topicals (including those we sell on our website) have a greater than 30% success rate. So if you are going to use them, go with the less expensive brands.
Do you have any information on Light Age Inc’s Q-Clear laser system which is marketed as clearlybeautifulnail mobile laser (clearlyBeautifulNails.com)?
Unfortunately, this is just another company trying to make some money by jumping on the fungal nail bandwagon. They have absolutely no evidence that this laser works for treatment of fungal nails. Save your money.
Hello. Just wanted to say how happy I am to have found your site. Your honesty about toenail fungus and its treatment is refreshing. I am 35 and almost all of my toenails have fungus. A female with toenail fungus-HORRIBLE.
I have two children and 1 bathroom and am completely paranoid about giving the fungus to them. Before their baths I spraya disinfecting solution in the tub to try to ensure all fungus is gone.
I tried Sporanox 5 years ago and it cleared my nails but then I got pregnant and the fungus came back. I guess I will try Lamisil again. Right now I am soaking my toes in apple cider vinegar and using tea tree oil b/c I am still breastfeeding. I am crossing my fingers that a laser gets approved b/c I absolutely hate my feet, but more importantly, don’t want to give it to my hubby or little ones!
Thanks again for your site.
We would love to see a laser that works also. Unfortunately, what we see so far is misleading advertising. There is still no good evidence that the lasers work to treat nail fungus.
I’ve had toenail fungus for many years. For some toes the toe nail bed and the toe nail have merged. So when I cut the nails there is blood and pain. I can’t see how laser treatments would have any chance of success with that co-mingling. Is there a way I can at least reclaim the toe nail bed?
You are right – lasers won’t work for this problem. In fact, they don’t work for any fungal nail condition.
You might have an easier time grinding your nails instead of cutting them. Here are instructions.
Question: I have tried many things for nail fungus, and as you mentioned many times the pills works best. I have used that twice, but the fungus returns! What about Formula 3 from Tetra Corp? I am currently using the protocol from your website without success. What help is there?
Unfortunately, there are not any great treatments for this problem. I have not seen any evidence that Formula 3 is any better than any of the other topical medications.
Hi,
First- thanks for your website.
I got my fungal infection from a pedicure. I left the polish on for two weeks and when I removed it, I noticed some white areas on one of my toenails. I asked the pedicurist about it the next time I saw her and she said that my nails were just dry. I believed her and just kept moisturizing my nail (for a couple of years) until it finally got to the point where it was clearly something besides dryness- my toenail was half-white and had started to separate from the nailbed. By that time, I noticed the same type of white color on some of my other nails.
I tried Lamisil for 4 months and it didn’t seem to do any good, plus I think it was hurting my liver as my urine was very dark while I was taking it and I broke out in hives about two weeks into treatment.
Then my doctor prescribed Penlac. It worked clearing up my less affected toenails but didn’t seem to help the first one.
Questions-
1) So today, I had the doctor remove what was left of my infected toenail (I had been cutting it back almost to the nailbed since there was no pain). My hope is that the nail will grow back uninfected. What are the chances? What if I religiously apply tea tree oil and/or Penlac as it is growing back? Or if I go on another round of Lamisil while it is growing back?
2) I don’t understand the mechanism for re-infection. I had never had problems before that pedicure. If I am able to get rid of the infection and practice good hygiene and avoid pedicures, why would I be any more susceptible to getting a re-infection? Does having the infection once somehow predispose you to getting it again? If so, how? Is my immune system compromised or does the fungus continue to reside in the body like the herpes or chickenpox virus?
3) To avoid the fungus from reappearing/spreading, do I need to stay away from nail polish on my other toes?
Thanks so much for your time.
Question 1): Applying those medications while it grows back could not hurt, although I can’t predict if they will help. The truth is that they probably won’t.
Question 2): You may have already been one of those people who were susceptible. You just may not have been exposed before.
Question 3): I have not seen any evidence that nail polish makes you more likely to get a fungal infection.
Dear Sir/Madam:
I have a nail fungus and have taken oral medication, Griseofulvin (spelling?), for it and it cleared up temporarily. I was told not to take this medication again as it is very hard on the system.
I am trying to keep this under control with your recommended cream, do not recall the name at the moment, and this seems to be working slightly. I have four nails all tolled (both feet)and wonder if a Laser treatment would be effective. Because it is so expensive, I have not done this.
Would appreciate your feedback.
Thank you,
Myrna McIntosh
Hi Myrna,
Unfortunately, there is no evidence that the lasers are effective at treating nail fungus. The most effective treatment currently on the market is oral terbenfine (Lamisil). I would talk to your podiatrist about it.
I was diagnosed with toenail fungus over 25yrs. It is on two toes of my left foot. I have tried over the counter medications including tea tree oil to no avail. I have read one year in my local magazine that urea acid may help. Have you heard anything regarding this. I always wanted a pedicure but do not go since I do not want to spread this to others. Any advice. I am definately not interested in an oral pill.
There is no evidence that any of the topical medications work more than 20% of the time. Given that, however, they can’t hurt either.
The only treatment that has been shown to work more than 60% of the time is the oral medication Lamisil. Since you don’t want to take that, there isn’t much choice but to keep the nail thin.
I saw where you doctors recommend Juzo antifungal socks. My cardiologist has me wearing thigh high compression (20-30 mg) socks. I skip a day now and then for various reasons and wear crew or ankle socks (non-binding if there are clean ones available). But I get a swelling of the leg just above where the sock ends. Less so if they are non-binding socks. If I bought the Juzo sock, would that cause more sweling than the average sock as they are compression socks?
Every sock with compression will decrease swelling in the area covered by the sock. Wearing crew and ankle high compression socks, therefore, may result in an appearance of increased swelling above the sock level.
I hope that answers your question.
Just to confirm I had clear nail polish on my nails while being lasered. Do I need to worry about safety or health issues.
No safety or health issues at all, although I usually have my patients remove the polish to prevent sparking during the procedure.
I was wondering why most of the posts are from 2011 and only the last 2 are from April 2016?
Do you have any recent information on laser treatment for nail fungus?
I wish we did. There have been no substantial studies on laser treatment for nail fungus in the last several years. Right now the best studies show that 50% – 70% of patients will see some improvement. In general oral terbinafine is a much more effective treatment than laser for nail fungus. There is one study that says the combination of the two treatments is better than either alone. If you are not a candidate for the oral medication then laser is likely the next best choice.
Our primary two pages on nail fungus treatment and laser treatment are constantly updated. Those can be found here:
Guide to Fungal Nail Treatment
Laser Treatment for Fungal Nails
It the treatment safe during pregnancy?
Probably, but there are no studies on the safety during pregnancy so we will not perform it on pregnant women.