Nail fungus (onychomycosis)

Overview

Nail fungus (onychomycosis) is very common – among people over 60, around 20 to 30 per cent are affected. Most often the toenails are involved, frequently accompanied by athlete's foot with scaling on the sole and between the toes.

We follow a combined treatment concept: laser treatment of the nail, a topical therapy with creams, gels and nail lacquers, where needed a systemic (internal) treatment, as well as podiatric nail care in our practice.

Areas of application

• Nail fungus of the toenails
• Nail fungus of the fingernails
• Nail fungus in combination with athlete's foot

Procedure

1. Diagnosis and concept

   First we confirm the diagnosis – usually by detecting the pathogen (microscopic examination, fungal culture or a molecular examination), as other causes can also lie behind an altered nail and a systemic treatment requires a confirmed detection of fungus. We then determine the individual treatment concept; often a combination of several components is sensible.

2. Podiatric preparation

   The nail is filed down podiatrically as short as possible so that the laser light can penetrate the nail plate more effectively.

3. Laser treatment

   The nail is treated with a long-pulse Nd:YAG laser; the laser light penetrates the nail plate and selectively heats the nail structures. The procedure is designed to spare the surrounding tissue (nail, nail bed, nail matrix, nail fold). The treatment is low in pain and requires no anaesthesia.

4. Accompanying therapy

   In addition, topical antifungals (creams, gels, lacquers) and – depending on the findings – a systemic treatment are used. At the start, three laser treatments at intervals of four to six weeks are usually recommended.

What to expect

• The laser treatment is low in pain and requires no anaesthesia.
• At the start, three treatments at intervals of four to six weeks are usually planned.
• A nail grows slowly – healthy regrowth only becomes visible over the course of months.
• Nail fungus can often be treated best with a combined concept; the overall duration depends on the individual findings.

Risks & notes

• During the treatment, a sensation of warmth or pressure on the nail can occur.
• The treatment outcome varies from person to person and cannot be guaranteed; nail fungus can recur.
• The scientific evidence for laser treatment of nail fungus on its own is limited and inconsistent; the laser is therefore used as one component of a combined concept.
• Very rarely, if too much heat is applied, a small burn or blistering at the nail margin can occur; the energy is adjusted to your sensation.
• A systemic (tablet) treatment can interact with other medications and may make laboratory checks (e.g. liver values) necessary; whether it is sensible is something we assess individually.
• Consistent foot and shoe hygiene as well as the concurrent treatment of accompanying athlete's foot are important in order to avoid re-infection.
• Laser treatment of nail fungus is generally a self-pay service.

Frequently asked questions

Is the laser treatment painful?

No, it is low in pain and requires no anaesthesia. During the treatment, a sensation of warmth on the nail can occur.

How many treatments do I need?

At the start, three treatments at intervals of four to six weeks are usually planned. As the nail grows slowly, healthy regrowth only becomes apparent over the course of months.

Why is the laser alone often not enough?

Nail fungus responds best to a combined concept: laser, topical and, where appropriate, systemic therapy as well as podiatric care. It is also important to treat any accompanying athlete's foot at the same time.