Treatment

The treatment outcome can be reached by a single or double session, but it depends on the severity of the fungal infection. The outcome, the growth of new clear nail structures is therefore not immediately visible. Nevertheless, in about 8 weeks after the initial treatment the first new formed clear nail structures are discernible. If this is not the case, an additional treatment could be implemented. A 3rd treatment (ca. 8 weeks after the 2nd treatment) could be necessary if the fungal infection is very definitive. The ultimate result should be visible in 9 month till one year.

Initial situation             7 weeks after initial treatment

Pre-treatment tests

Onychomycosis could be bred by different pathogens like e.g. dermatophytes, yeasts or mildew. The pathogen should be microbiological analyzed beforeeach laser treatment. The treating physician should subsequently classify the results in respect to its pathogen relevance. At the presence of an hyper-keratotic infections the infected nail stuff should be removed mechanically – it is not necessary if an atropic infection is present. Projecting infected nails or applied nail polish has to be removed in any case.

Treatment parameter

The duration of the treatment depends on the size of the toenails, the laser settings and the speed of the movement. The laser beam should continuously (ca. 2 mm/s) guided over the nail bed, so that the complete nail (nail plate, nail wall and eponychium) is repeatedly irradiated reticular or spiral-shaped.

Due to the applied total energy there has to be a notable warming perceptible. The treatment could be temporary (about 5 seconds) paused, if the patient feels a heating pain before the necessary total energy is reached. After each treated nail the automatic pulse countershould be reset by a singular touch.

After the treatment, there will be a lingering sensation of heat below the nail.

This sensation will dissipate within 1 - 2 hours.

Post treatment care

The advantage of the laser treatment is – when correctly applied – it has no side effects. To avoid an infection of the proximate nails the patient can use an antifungal cream.

Methods in case of unwanted effects

The application of laser radiation can cause a burning of the tissue, which results in necrosis. Measures to treat burns have to be realized.

Second, the laser radiation causes haemostasis and the tissue gets coagulated. The amount of irreversible damaged tissue depends on the time and extend of the coagulation. Coagulated tissue is not harmful and does normally not cause any problems. In case of overheating of temperature-sensitive areas (nail wall) intensive cooling is recommended. If the surgeon applies too much energy at the edge of the treatment area (nail wall) it is comparable to burn wounds. The following clinical procedures should follow the guidelines.

Treatment related issues

Discomfort from the heating which is generated by the laser may occur. To avoid this, the user should avoid too long application times. If possible, cooling can reduce patients discomfort after the treatment. All personal, including the patient, have to wear eye protection goggles; this may lead to decreased vision regarding contrast and color by the personal and surgeon.

In case of any eye injury due to disregard of the eye protection by safetygoggles, an ophthalmologist has to be consulted.