Nail fungus (onychomycosis)

Overview

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

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

Areas of application

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

Procedure

1. Diagnosis and plan

   First we confirm the diagnosis, as a rule by detecting the pathogen (microscopic examination, fungal culture or a molecular test). Other causes can lie behind an altered nail, and a systemic treatment requires confirmed evidence of fungus. We then set the treatment approach; often a combination of several components makes sense.

2. Podiatric preparation

   The nail is filed down podiatrically as short as possible, so that the laser light can pass through the nail plate more easily.

3. Laser treatment

   The nail is treated with a long-pulse Nd:YAG laser; the laser light passes through the nail plate and heats the nail structures selectively. The method is designed to spare the surrounding tissue (nail, nail bed, nail matrix, nail fold). The treatment causes little pain and needs no anaesthesia.

4. Accompanying therapy

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

What to expect

• The laser treatment causes little pain and needs no anaesthesia.
• At the start, three treatments at intervals of four to six weeks are as a rule planned.
• A nail grows slowly, so healthy regrowth only becomes visible over months.
• Nail fungus can often be treated best with a combined approach; the overall duration depends on the findings.

Risks & notes

• During the treatment a sensation of warmth or pressure on the nail can occur.
• The outcome differs from person to person and cannot be guaranteed; nail fungus can recur.
• The scientific evidence on laser treatment of nail fungus on its own is limited and inconsistent; the laser is therefore used as one component of a combined approach.
• Very rarely, if too much heat is applied, a small burn or blistering at the nail margin can occur; the energy is adjusted to what you feel.
• A systemic (tablet) treatment can interact with other medicines and may make laboratory checks (e.g. liver values) necessary; we assess beforehand whether it makes sense.
• Consistent foot and shoe hygiene and treating any accompanying athlete's foot at the same time matter, so that you do not become infected again.
• Laser treatment of nail fungus is as a rule a self-pay service.

Frequently asked questions

Is the laser treatment painful?

No, it causes little pain and needs 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 as a rule planned. As the nail grows slowly, healthy regrowth only becomes apparent over months.

Why is the laser alone often not enough?

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