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Fungal Nail Infection is very common in the general population and is estimated at 8% worldwide but likely occurs at an even higher rate in tropical climates like Viet Nam (possibly at or above a 10% rate), while in certain populations (older patients, patients with diabetes, or patients with an immune deficiency) it may occur in as great as 26% of these patients!  Fungal nail infections account for about one half of all nail abnormalities and represent one-third of all fungal infections of skin (nails are considered part of the skin).  Thus, the burden of fungal nail infections is massive.

Fungal nail infection (Onychomycosis) can cause much distress and can lead to some considerable adverse effects; unsightly nails, difficulty in managing nails hygienically, and it also can lead to pain and inflammation at times.  The infection can destroy the protective barrier and function that the nails serve as, and the nails and skin areas around the nails can become secondarily infected with much more concerning bacterial pathogens that could cause more serious skin infections.  It is well recognized that due to its troubling adverse effects that this condition leads to, fungal nail infections should be treated in view of the physical and emotional handicaps it produces.  However due to the special structure and nature of toenails (and fingernails), and the complicated nail apparatus, this infection leads to many obstacles in the ability to successfully treat this condition.

Fungal Nail Infection (Onychomycosis) is not only a cosmetic concern, but in addition can cause serious medical, social and emotional problems.  The primary concerns of affected patients is usually the risk of spread to other nails or to other people, having others notice the deformed nails, and the very real feeling of being unattractive due to this condition.  These social and emotional problems are greater in cases in which fingernails are involved, greater in women, and in patients of younger age, greater in those usually better educated and those living in urban population centers.  The fungal nail infections in affected patients may lead to a lowered self-esteem and body image, a sense of inadequacy, and even depression.

Topical antifungals (applied antifungal lacquers and creams), quite frankly, have a miserable chance of cure, which in the medical literature has a 10-15% chance of being effective after being applied every day for 1 year or more.  And this type of external application can only affect a cure for the most superficial fungal nail infections.  There is almost zero chance of cure for such externally applied topical antifungal lacquers and creams for deep nail infections that the majority of people are apt to have.

Oral antifungal medications have a much higher rate of effectiveness compared to topically applied agents. The downside with these oral antifungal medications is that they must be taken for extremely long courses, generally from 4-9 months. Besides the long periods of treatment the disadvantages are;

These oral agents are expensive.
The oral agents are not completely effective even after such long courses and relapses can occur. Oral antifungal agents can cause serious adverse effects with the liver, especially if alcohol or other medications affecting the liver are consumed/taken.

These major factors make taking oral antifungals a potentially dangerous option for what many patients, and physicians as well, view as a simple infection that treatment should not carry such serious risks or downsides.  Such oral antifungal medications, when prescribed for such long periods require regular follow-up with liver enzyme monitoring, and making sure the patient is not taking any additional medications (or alcohol) that could lead to liver damage.
 

Given all of the above possible complications and difficulties it is with great enthusiasm that we are now seeing a very effective treatment emerge using a special laser modality that can treat toenail and fingernail infection locally without exposing the patient to potentially serious liver toxicity.  The new laser treatment appears by all measure to be thus far, more effective than oral antifungals (and much more effective than external/topical creams and lacquers), without any systemic side effects.  It’s cost is significantly less than the long courses of oral antifungal medications, and it appears have an advantage in improved effectiveness as well.  As there are no systemic adverse reactions, patients do not have to be monitored by blood tests like the oral antifungal medications, further reducing the costs, and improving upon safety.

The laser employed by Stamford Skin Centre for accomplishing the elimination of Fungal Nail Infection is the Clarity Laser which is a laser modality that delivers the same laser wavelength and laser energies that were used in a landmark study showing just how effective this laser wavelength is for eradicating nail fungus infections.  In this landmark study it was shown that 4 sessions 1-2 weeks apart, were extremely effective.  Treatment sessions require only minutes, while during this time 3 passes over the infected nails are made with the laser.  The laser works by heating up the fungus and striking what are termed “chromophores” (molecules that selectively absorb much more of the laser energy than surrounding normal nail proteins) within the fungus and thus lead to destruction and killing of the fungus infecting the nails.  The level of discomfort for most patients is minimal, and at Stamford Skin Centre our Clarity Laser has a pre-cooling capacity to minimize to the greatest degree the discomfort that may be experienced.

 

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