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Toenail fungus fight turns to lasers

Offer an effective treatment for toenail fungus and the world will, apparently, beat a path to your door.

Several local podiatrists have recently acquired a laser that's designed to quickly, safely and painlessly kill the unsightly and potentially dangerous fungus that takes hold under some people's toenails. They've been seeing a steady stream of patients willing to pay hundreds of dollars for the treatment.

"We got the laser a few months ago and we've been really busy ever since," said Clearwater podiatrist Dr. Fred Kussel.

How it starts

Nail fungus, or onychomycosis, often starts with a small white or yellow spot under the nail. As it progresses, the nail gets darker, thicker, and can be brittle. It also can be painful.

The fungus that gets under your toenails is the same one that causes athlete's foot. Tampa podiatrist Marc Katz said patients with toenail fungus usually have athlete's foot first, although it may be such a mild case that they didn't notice.

You can get it at any age, but it's more common in older people, perhaps because blood circulation decreases with age, nails naturally get thicker and slower-growing, and conditions associated with age, such as diabetes, also are connected with toenail fungus.

The condition has long been treated with topical solutions or oral medications, such as Lamisil. But both those treatments can take months and have rather dismal success rates — less than 50 percent. Oral medications can have negative side effects as serious as liver damage, so many people can't take them.

Laser attack

Kussel, Katz and other area doctors are now using a laser called CoolTouch.

"Essentially, it brings the nail up to a temperature that it kills the fungus, but it doesn't damage the tissue underneath," Katz said.

One way the laser does that is to sense the temperature of the nail. When the nail starts to get too hot, the laser shuts itself off and immediately applies a cryogenic spray, quickly cooling the nail before the skin underneath burns.

The treatment generally kills the fungus completely in one to three sessions, but it may take time for discoloration to disappear.

The treatment is not inexpensive. Kussel charges $699 to treat all 10 nails, which he recommends even if the fungus is only evident in one or two toes, since this pesky condition can so easily recur.

Some doctors recommend having a biopsy first to make sure onychomycosis is the problem. Trauma and psoriasis can look a lot like toenail fungus. The biopsy in this case involves taking a clipping from the nail, so Kussel recommends that patients not trim their nails before their first visit to the doctor.

Although the CoolTouch laser is FDA approved for other uses, doctors are using it off-label to treat toenail fungus while the approval application is pending. Even when it is approved, it often may be considered a cosmetic procedure, not be covered by insurance.

But toenail fungus is not solely a cosmetic issue. If not treated, toenail fungus can lead to the loss of the nail, and in people with diabetes or certain other conditions, it can even cause infections that necessitate amputation, Kussel said.

A lot of people go through their whole lives without getting toenail fungus. Others get it repeatedly because their immune systems don't fight off the fungus.

"Some people are more susceptible to it," Katz said. "It can even run in families."

The spores are all around, in the air, and it's impossible to avoid them. But there are measures (see box) you can take to minimize the chance that the spores will develop into a fungus.

Even if you take all the precautions, doctors say there's a decent chance you'll end up with onychomycosis at some point. Toenail fungus isn't something a lot of people talk about, and when they have it they try to conceal it. So a lot of people don't realize how common it is. Kussel said 50 percent of people older than 40 have toenail fungus.

Marty Clear is a Tampa-based freelance writer.

Minimize your fungus risk

Dr. Fred Kussel and Dr. Marc Katz offer these tips to minimize the risk of toenail fungus:

• Katz advises rotating shoes, never wearing the same pair two days in a row. All fungi like dark, damp environments, so giving your shoes a chance to dry thoroughly makes it harder for them to grow.

• Kussel recommends spraying a fungicide into your shoes regularly.

• People who get toenail fungus regularly may want to change their socks a couple of times a day.

• Make sure your shower is clean, and consider wearing flip-flops in community showers.

• Dry your feet thoroughly before you put your shoes and socks back on.

• Limiting use of polish on toenails can also help.

Toenail fungus fight turns to lasers 09/10/10 [Last modified: Tuesday, November 9, 2010 5:44pm]
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