BY NORM TOLLINSKY
A new laser treatment for fungal nails is being offered by the DeSimone Foot and Ankle Centre in Sudbury.
The Q-Clear Q-Switched Nd:YAG laser from U.S.-based Light Age Inc. was developed for treating pigmented lesions such as sun-damaged skin and age spots, and for the removal of unwanted tattoos, but is also an effective treatment for onychomycosis, a fungal infection of the bed and plate underlying the surface of the nail.
Laser treatment is an alternative to systemic anti-fungal medications such as Lamisil (terbinafine hydrochloride), which are hard on the liver and require periodic blood tests to monitor side effects.
There are also anti-fungal topical solutions, which have to be applied daily for a year or longer. Topical solutions stop the fungus from reproducing, but don’t kill it, “so, if you forget one night to apply the medication, it’s almost as if you’re starting back at square one because you’ve allowed reproduction to occur,” said chiropodist Dr. Julie DeSimone.
Conventional treatments are often unsuccessful because of incomplete follow-through. As a result, patients often give up and resign themselves to living with their yellow, thickened and foul-smelling toenails.
Laser treatment, by comparison, is quick, easy, painless and successful 70 to 80 per cent of the time, said DeSimone. Two 10-minute treatments four weeks to three months apart are all that’s necessary, but success also depends on patient compliance to avoid recontamination.
A success rate of up to 90 per cent is possible with adherence to a strict protocol that includes treatment of all nails (even uninfected ones) and the use of topical anti-fungal agents and shoe sanitizers such as SteriShoe, which employs ultraviolet light to kill fungal spores.
DeSimone purchased the Q-Clear laser with five fellow chiropodists from southern Ontario to make the treatment more affordable. Instead of charging the going rate of $700 per foot for each treatment, the DeSimone Foot and Ankle Centre charges $500 for both feet, including the follow-up treatment. Some private health plans cover it. Others don’t.
The laser is couriered from one participating chiropody clinic to another in accordance with an agreed upon schedule.
Fungal nail infections can be picked up in public pools, gymnasiums, fitness centres, as well as change rooms at mine sites, which are “horribly infested,” said DeSimone.
Fungus thrives in hot, damp environments and can be easily transmitted from person to person. Diabetics are particularly vulnerable.
The solution is to always wear flip flops in public showers, pools, hotels and change rooms, avoid wearing other people’s shoes, and to make sure that nail clippers and other instruments used in nail salons and in the home are properly sterilized.
Avoiding cross-contamination also requires the use of anti-fungal sprays on shoes, socks and sheets.
Light Age investigators first proposed the application of the Q-Clear q-switched laser on fungal nails in 2005, but the first clinical study began in March 2010 at Southwest Foot and Ankle in Cleveland, Ohio. Most other laser systems are not “q-switched” and cannot produce the same effect. Q-switched lasers are capable of producing very high power in extremely short pulses lasting a few billionths of a second.
The company provides in-service training at the time of installation, but recommends additional training at the company facilities in Somerset, New Jersey, or through certified laser courses.
The Q-Clear laser system sells for $35,000.
www.desimonefootclinic.com
www.light-age.com
