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Onycomycosis

It’s clear! Eclipse® 1064 clears the nail fungus!

Onychomycosis is a fungal infection of the nails, which can lead to adverse health impacts, particularly in elderly and immunocompromised patients. It is notoriously difficult to treat. Current antifungal treatments include systemic and topical drugs. The efficacy of the topical drugs is impaired by their limited ability to penetrate the nail and reach the affected nail bed. Oral systemic antifungals are also associated with severe side effects.
 
Laser treatment of onychomycosis has emerged as an alternative to traditional antifungal therapy due to their minimally invasive nature and the potential for requiring fewer treatment sessions and without systemic side effects.

A variety of lasers were utilized in treating onychomycosis. From CO2 gas lasers to solid-state Nd:YAG operating at 1064nm and 1320nm. However, because there are no absorption bands at wavelengths emitted by these lasers specific to the fungi, it is not clear what would be the mechanism responsible for the fungi destruction, and most likely the effect is purely thermal. It has been proposed that the 532nm Nd:YAG may be better at targeting xanthomegnin – the pigment produced by the nail fungus, which has peak absorption between 406 and 555 nm. However, the penetration depth of the green light is only a small fraction of a millimeter, thus it cannot get under the nail plate. Therefore it is not clear if it could have any utility for treating patients.
Semiconductor diode lasers may represent a better alternative to solid-state and gas lasers in treating onychomycosis, as their wavelength can be selected to target chromophores in the fungus. It was discovered in in-vitro studies that high fluences (4,074 J/cm2) of dual-wavelength 870/930nm diode laser resulted in 100 % eradication of bacteria, fungi, and yeast. In an attempt to reproduce these positive outcomes patients were treated by 870/930nm diode laser with less total energy. While an independent panel noted significant clinical improvement, only about one-third of patients had both clear nail growth and negative mycological cultures.
Despite some success stories, still, there is a lot of controversy about the efficacy of laser treatment of onychomycosis. Published data range from 75% effective to mostly useless. In our opinion, the heterogeneity of the outcomes is the result of huge variations in the treatment protocols – the wavelength, power, and dose of the laser light applied, number and frequency of treatments, as well as in methods of assessing the endpoints – mycological cure, clinical improvement, clinical cure, and Onychomycosis Severity Index.

In our opinion, the biggest source of inconsistency is the equipment that was used for treating patients. Every commercial laser system for treating onychomycosis produces a small spot size on the treated surface (usually diameter of 4mm or less). To cover the entire nail plate and surrounding tissue, the operator has to move the beam across the treatment area. However, such a procedure produces a highly nonuniform distribution of the deposited laser energy. A common endpoint for treatments is when the patient cannot tolerate the heat. But the sensation of pain indicates that the temperature under the nail had reached the pain threshold only at a certain point, while everywhere else the temperature may be too low for efficacious treatment. OmniLase’s Eclipse® 1064 is the first laser system that addressed the uniformity issue and provides consistent results. It delivers a highly uniform beam that completely covers the entire nail plate and adjacent tissue, thus achieving the target temperature without pain sensation.