Fungal Nail Infections

Onychomycosis, or fungal nails, is sadly a very common condition accounting for over 50% of all nail pathology and is known to affect 6-8% of the population. It is unsightly and causes foot odour but its most frustrating quality is that it has been very difficult to treat.

Most people don’t realize they have a fungal nail problem until the condition has been present for many months, by such time it has spread to a level that is not treatable by conventional topical treatments. Moreover, most sufferers do not seek treatment until the infection has spread through the entire nail or to other nails.

The major difficulty in managing fungal nails is that the infection is present in both the nail plate and the nail bed beneath the plate. The fungi attack the nail and survive by ingesting the protein structures that makes up the nail, known as keratin. When the fungus starts to take over large sections of the nail plate it may become thicker, yellowish-brown or darker in colour and often odourless.

Common symptoms of a nail infected by fungus include:

  • Discoloured nails.
  • Yellow streaks under the nail.
  • Distorted or thickened nails.
  • Brittle, crumbly or ragged nails.
  • Nails separated from the underlying nail bed.
  • Build-up of debris (nail fragments, skin) under the nail.
  • White spots or streaks on the nail surface.
  • A white powdery appearance on the nail surface, commonly seen after wearing nail polish for prolonged periods.

As the fungal nail infection advances, the nail can become thick, brittle and separate from the nail bed. With advancing deformity of the nail it is possible for a secondary bacterial infection to develop. If you suffer from Diabetes in particular, this can be an unwanted and serious complication.

Treatment options for fungal nails in the past have been topical nail paints, oral medication and surgical removal of the nail.

Topical nail paints need to be applied for up to one year and have poor clinical success in moderate to severe cases. Oral medication has a clinical success rate of approximately 60-70%. However a number of side effects make its use difficult for many users. These include allergic reactions, taste disturbances, hair loss, nausea, loss of appetite and, of greatest concern, liver and kidney disturbances. Most GP’s will recommend patients to undertake liver function studies prior to using the drugs and re-test monthly for the 12 week duration of the treatment. The antifungal drugs are contraindicated for use in children, pregnant and breast-feeding mothers, persons with any history of liver or kidney pathology and for those using certain medications, including warfarin and certain diabetic drugs.

Surgical removal of the nail plate and treatment of the nail bed with topical anti-fungal cream can be successful but the post-operative discomfort and disfiguration as the nail re-grows is a deterrent for most people.

Recently there has been a significant scientific breakthrough in the treatment of fungal nails. The treatment has no side effects. Cutera USA has developed the Genesis Plus laser for the safe and effective treatment of fungal nails. Studies undertaken in both the U.S.A and Japan show success rates of 85% in controlled trials.

How Does The Genesis Plus Laser Work?

Genesis Plus is a Nd:YAG 1064nm laser with a light penetration depth of 3 mm. The Genesis Plus is  approved for use by the TGA in Australia that has been purpose built for the Podiatry profession to be used to treat fungal nails.

When used to treat fungal nails, the laser light passes through the nail plate and the surrounding tissue into the nail bed. The laser light is absorbed by the pigment in the fungi which is darker than the surrounding cells, and this causes the fungi cells to heat. This small rise in temperature kills both the fungi and its spores and, as your nail continues to grow, the infected area grows out with it. This can take from 4-12 months. How many treatments are needed for the Genesis Plus to achieve these results? Treatment length will vary dramatically depending on the severity of the infection but the average is usually 3-4 sessions. Many clinics advertise that single treatment programs can work but this claim has not been substantiated in any published clinical trial in a noteworthy medical journal.