Toenail fungus, aka onychomycosis, is a very common problem. The numbers vary depending on the source, but we are talking 20-30 million in the U.S. alone. Most are mild cases, which are not accounted for because people do not go to the doctor to diagnose their smelly feet with ugly deformed nails.

Several laser companies are working on clinical studies and FDA approvals, but practitioners do not have to wait – they are free to perform off label procedures with the lasers they own or rent.

Anecdotal evidence is growing to confirm that laser treatment of the fungus is a lot more efficacious (75-90% cure rate) than topical solutions (8-10%) and oral medication (30-40%). Lasers are quickly becoming a new way to treat nail infection by selectively irradiating fungi while leaving the nail and surrounding tissue intact.

Onychomycosis is more common among people over the age of 50 who should avoid toxic medication. Podiatrists and other physicians who have started performing these treatments charge from $850 to $1,400 per treatment (all toes have to be treated at the same time). Thus, the market for non-invasive, drug free (only topicals for prevention) and simple laser procedures is huge, a billion-dollar-plus per year huge.

Currently only a few hundred doctors in the U.S. offer the laser therapy and they are not easy to find. A medical referral service called Laser for Toe specializes in setting up free doctor appointments for people with toenail fungus. They can find a laser doc near you.

As I continue to review the Medline English literature and recent international conferences regarding Fractional photothermolysis (FP) technology, applications, and indications, it becomes more obvious that this relatively new modality is one of the most significant milestones in laser technology and skin resurfacing.

Successful conditions treated with non-ablative fractional lasers reported in the literature include acne scarring; dyschromia and fine wrinkling of photoaging on the face, chest, neck, and hands; melasma; poikiloderma of Civatte; nevus of Ota; scars; minocycline hyperpigmentation; telangiectatic matting; residual hemangioma; granuloma annulare; colloid milium; and disseminated superficial actinic porokeratosis.

An advance in 2007 was the introduction of ablative FP (AFP), which results in significantly greater improvement in skin laxity and textural abnormalities. There is no doubt that AFP has demonstrated significantly greater improvement than non-ablative FP in reducing acne scarring and skin redundancy and laxity associated with photoaging.

Through the induction of microthermal zones of injury, FP technology stimulates a robust and rapid wound healing response resulting in improvement in a diversity of aesthetic, inflammatory, and preneoplastic skin disorders.

Further investigation into the technology and diverse array of cutaneous conditions that can benefit from FP will continue and bring additional data to use in determining treatment parameters and identifying new apppliations.

The concept of non-ablative fractional photothermolysis was introduced to the market in 2003 as an answer to the need for effective, yet low risk, skin resurfacing techniques. Unlike conventional ablative (CO2 and Erbium) and non-ablative lasers, fractional ablative and non-ablative photothermolysis treats only a fraction of the skin, leaving up to a maximum of 95% of the skin uninvolved. The undamaged surrounding tissue allows for a reservoir of viable tissue, permitting rapid epidermal repair.

Non-ablative fractional photothermolysis is currently approved by the US Food and Drug Administration (FDA) for the treatment of pigmented lesions, periorbital rhytides, skin resurfacing, melasma and soft tissue coagulation, acne and surgical scars, and actinic keratoses. However, its off-label use is clearly more extended. Many practitioners would agree that this first wave of fractional lasers has delivered very limited clinical efficacy.

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In 2007 the concept was further developed, and ablative fractional photothermolysis was introduced, using an erbium yttrium aluminium garnet (Er:YAG) or carbon dioxide (CO2) laser. These devices are FDA cleared to treat wrinkles, rhytides, furrows, fine lines, textural irregularities, pigmented lesions and vascular dyschromia. Read the rest of this entry »