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Nail fungus or onychomycosis is a fungal infection of the nail plate, nail bed, and nail matrix that effects millions of people. The infection is usually caused by Trichophyton rubrum species, which can be seen as septated hyphal elements on a KOH prep, as bellow. Often this fungal nail infection manifests in thickening, discoloration, brittleness, and nail debris. Certain conditions such as chronic fungal skin infections, like Athlete’s foot, or diseases which affect your immune system, such as diabetes, can put you at a higher risk to develop onychomycosis.
This novel treatment of nail fungus, FDA cleared since 04/07/2011, uses a 1064 nm wavelength of laser light to kill onychomycosis causing fungus in the nail plate, nail bed, and nail root. The laser is able to penetrate up to 3 mm in depth to ensure that all fungus and fungal spores are destroyed, without any pain or damage to the human tissues.
Studies show an 81% “complete” to “moderate” clearance of resistant onychomycosis with the Cutera Laser, with no side effects*. At Advanced Podiatry Clinics, from our experience the success rate has been even higher. The efficacy is significantly higher than topical or oral medications. * Kimura U, Takeuchi K, Kinoshita A, Takamori K, Hiruma M, Suga Y. J Drugs Dermatol. 2012 Apr;11(4):496-504.
Your treatment will consist of an initial evaluation by Dr. Igor Dukarevich or Dr. Claude Harb to make sure that you are a candidate for the laser treatment of onychomycosis with the Cutera laser system. Clinical photographs will be taken. We will also confirm the presence of the fungal infection either by a KOH stain directly in our office, or a by a PAS stain and fungal culture performed by Bako Pathology Services or 4 Path Lab. Your nails will be debrided and filed down to the optimal thickness for laser penetration. The Cutera laser treatment will be performed by Dr. Claude Harb, our specialist in the Cutera laser nail treatment. During your visit, your shoes will be sanitized with an ultraviolet shoe sanitizer. We will also recommend a shoe spray and an anti-fungual nail lacquer to prevent future reinfection. The recommended treatment protocol by Cutera and previous studies is three laser sessions about 1-2 months apart.
At this point, most insurance carriers consider onychomycosis to be a cosmetic disorder and strictly limit the coverage of the treatment. Laser treatment of onychomycosis is usually a non-covered service. You should check with your insurance company individually to inquire about your benefits. Often, this service can be covered with a flex spending account. Advanced Podiatry Clinics will provide you with a service receipt after your treatment, which you may submit to your insurance company. Please call our office at (708) 450-0705 for more information on cost of the treatment, coverage, and scheduling.
Two to three months after beginning laser treatment, you will start to see the new and healthier nail grow from the nail root. For maximum improvement, you will need to wait for the nail to fully grow out, which may take up to 9 to 12 months. A chronic fungal infection often damages that nail root and the nails may grow even slower.