There have been a number of lasers on the market varying in type and by wavelength. Over the years there have been many laser companies claiming that they have good results. Still, to date there is no actual single protocol for laser toenail fungus treatments. The treatments vary by the company and by each individual doctor. As a result, there have been no solid studies to prove that the laser can cure toenail fungus. As a matter of fact, the FDA clearance for laser machines states that it is for “temporary increase of clear nail in patients with onychomycosis.”
In a study by Jager, Oesterhelt, Et Al, they found that no patient had a fungal cure in 12 months of treatment and follow-up. In 2016, in Podiatry Today, Tracey Vlahovic, DPM, a leader in Podiatric Dermatology noted that laser is not a reliable monotherapy for toenail fungus. In 2019, Harvard University noted that "there is still little information about its long-term safety and effectiveness". In the Journal of Fungi, Liddell and Rosen came to the following conclusion regarding laser therapy for toenail fungus, "The evidence to date has not indicated superior outcomes in long-term endpoints to standard of care systemic therapy and postulated anti-fungal mechanisms remain unverified. Despite the scarcity of peer-reviewed literature investigating this topic, lasers have quickly risen to be considered among viable treatments for onychomycosis. As many offices have previously acquired a laser device for prior indications, it is understandable that physicians would be eager to discover additional innovative applications for these devices. Financial incentives may also have a role in widespread adoption. Sufficiently powered randomized control trials compared to previously existing therapeutic options are needed before lasers are deemed a standard of onychomycosis treatment. Moreover, head-to-head comparisons between different laser devices would be required in order to determine which device is optimum for the various morphological types of onychomycosis and the assorted etiologic fungi."
With so many types of lasers and so many different treatment protocols, there truly is no way of knowing which types of lasers have better results and which protocols are best. In addition, there are no true studies to confirm the laser treatment effectiveness. When you combine all of that with the cost of laser treatments, it is difficult to recommend laser treatments for toenail fungus at this time. As noted in the studies above, traditional treatments were as good or better than laser therapy alone. There are many other treatments available to help with this condition.
Here at Gentle Foot Care Clinic, we will wait to see if new evidence supports the use of laser. At this time, we have found that it is not in your best interest to seek laser treatment and we will continue to offer traditional treatments for toenail fungus.
Karsai S, Jäger M, Oesterhelt A, et al. Treating onychomycosis with the short-pulsed 1064-nm-Nd:YAG laser: results of a prospective randomized controlled trial. J Eur Acad Dermatol Venereol. 2016; epub Aug 13