1. What is nail fungus or onychomycosis? 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.
KOH wet prep of a fungal nail specimen at Advanced Podiatry Clinics
2. What is the Cutera laser treatment for 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.
3. What other options are available for treatment of nail fungus? Prior to the invention of the laser treatment for nail fungus, the options for the treatment of this stubborn condition were extremely limited. They included the application of topical anti-fungal medication for years with minimal, if any results. The other option included taking an oral anti-fungal medication, such as terbinafine or itraconazole, for an extended period of time with risk of damage to the liver. Furthermore, patients with a history of liver disease or taking certain other oral medications, were not candidates for oral treatment.
4. How effective is the Cutera laser treatment? 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.
5. What will my treatment consist of? 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. Your nails will be debrided and filed down to the optimal thickness for laser penetration. During your visit, your shoes will be sanitized with an ultraviolet shoe sanitizer. The Cutera laser treatment will be performed by Dr. Claude Harb, our specialist in the Cutera laser nail treatment. For a video of a treatment, please click here. Three treatments have to be performed: the first at the initial visit, the second at 3 weeks, and the third at 3 months, to make sure that all fungal organisms and fungal spores are eradicated. You will also receive a shoe spray and a cream to prevent future reinfection.
6. How soon will I see results? Two to three months after the Cutera laser treatments, 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.
7. What should I do to prevent reinfection? Prevention of reinfection is a major part of your treatment. After your treatment with the Cutera laser, you will need to follow preventative instructions closely.
- Previous
foot condition, such as Athlete’s foot, bromhidrosis (smelly feet), or
hyperhidrosis (sweaty feet), need to be addressed with your treatment
- Always use socks from natural fibers such as cotton or bamboo
- Always wash your socks in hot water, adding chlorine if they are white
- Sanitize your shoes regularly either with the antifungal shoe spray or an ultraviolet shoe sanitizer dispensed from our office
- Allow your shoes to “air out” for at least 24 hrs between uses
- Avoid contact with fungal organisms: never where someone else’s shoes, avoid walking barefoot in public areas, and always use flip-flops in public pools and showers
8. Is this a covered procedure under my health insurance plan?
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.
