Toenail fungus, including laser treatments
New Medications to Treat Toenail Fungus
In the past few years there have been 2 new topical antifungal medications to become FDA approved. These 2 medications are Jublia and Kerydin, it has been the first time in decades that there have been new FDA approved prescription antifungal medications. These medications are being advertised on TV and in magazines and there have been a lot of patients asking about them. I will take this blog to discuss these medications.
Jublia (efinaconazole) has been getting a lot of media attention. Jublia has been advertising a toenail with fungus wearing a purple helmet having a boxing match with a fungus and winning. This medication works as an antifungal liquid topical medication. It is applied to the toenails affected with fungus daily for about 48 weeks. Many patients are shocked when I mention that most topical antifungal medication need to be applied for that long. But the fact is toenails grow approximately 1mm per month, so it takes about 9-12 months for the entire toenail to grow from start to finish. Having said that Jublia and all topical antifungal medications need to be applied for about a year.
How effective is this medication and what are the side effects?
There have been many studies to check the efficacy. A complete cure was noted in 15-18% of patients. The nails were “mostly clear” in 23-26% and there a mycological cure (microscopically clear of fungus) in 54% of patients. These percentages are the highest we have seen in this class of mediations.
A big question all patients have is what the side effects are. The side effects are in 2% of patients and are minor. They include the following: ingrown toenails, redness, blisters to the surrounding skin, itching, burning and pain.
What about Kerydin (tavaborole)?
Kerydin is a little less effective than Jublia. The complete cure rate is 6.5-9%, the mostly clear percentage is between 15-18%. The mycological cure rate is between 31-36%. Only 1% of patients have side effects and they are ingrown toenails, redness and a skin reaction called dermatitis
Which Medication is best for me?
Each person needs to talk to their physician about which medication is better for them. They are both very similar with slightly different effective rates. Women who are pregnant, may become pregnant or who are nursing should not go these medications.
Medical Lasers have many different uses within the medical field; some uses include Lasik eye surgery, cosmetic surgery, tumor removal, dental procedures etc. In the field of Podiatry Medical Lasers can be useful to treat many different conditions. In this blog I will discuss the relevance of lasers to the field of podiatry.
How do Lasers work?
LASER, which stands for Light Amplification by Stimulated Emission of Radiation, work by having an intense beam of light, of a specific wavelength, which then allows the beam to focus on a small area. By having the beam focus on a small area the Laser can be used for surgical work by removing a lesion, burning, destroying or cutting etc.
Are Medical Lasers safe?
Medical Lasers has a source of radiation that is minute, due to the fact that the source of light is so small that it is safe and poses no health risks. Due to the fact that the light is so small it allows a physician to treat specific lesions without destroying the surrounding healthy tissues.
How are lasers used in Podiatry?
In our private practice we utilize 2 different types of laser to combat many different medical conditions.
Our first laser, which is called Sciton Laser, more specifically JOULE ClearSense . This laser is used to treat toenail fungus (also known as onychomycosis) and plantar warts. As per the Sciton’s website, the way the laser works is that the temperature of the laser is high that is heats the nail and decreases the nail fungus and increases the growth of the healthy nail. (http://www.sciton.com/treatments/onychomycosis)
This treatment is painless and takes 15 minutes. We recommend 4 treatments within a 2 month period.
In relation to treating plantar warts, it is a onetime treatment, also using the ClearSense, that requires a local anesthetic prior to treatment.
What about other applications in Podiatry?
We use K laser in our office to treat many different alignments such as plantar fasciitis, Achilles tendonitis, and pain from residual ankle sprains. The way it works is to increase blood flow to an area, which will then increase the oxygen to the area and then increase the healing to the area. We recommend 10 treatments within a 5 week time frame. The treatment is under 10 minutes, is painless and you are able to drive home without sequela.
As technology advances, scientists are finding new ways to treat old conditions. I have had success with these lasers that I have not seen in the past, therefore, I recommend someone with these conditions to try the laser and they will notice the improvement of their conditions.