Nail fungus

Onychomycosis or nail fungus affects 10% of the world population, sometimes also affecting the patients' quality of life. It can turn to a chronic condition since it does not disappear without treatment. If fungus is found timely, this helps for its easy and fast removal. The key for a successful treatment is a valid diagnosis and preparation of an optimal plan of treatment with the aim to completely recover the nail health.

What you should know about nail fungus

Onychomycosis is the most common nail disease. If it is not diagnosed correctly and treated timely, it can lead to long-term treatment, which often discourages patients and makes them abandon it. Epidermophyton fungi or non-epidermophyton fungi and blastomycetes, also known as fungal pathogens, are considered a leading cause of the occurrence of nail fungus. The infection is caused by the invasion and formation of colonies of fungal pathogens in the nail bed.

The sensitivity of nails to fungi (particularly the toenails) is due to the fact that fungi live and grow in a warm and wet environment. For this reason, it is important to dry the areas between the toes very well. Also, the increased risk of onychomycosis may result from diseases such as diabetes, immunosuppression and peripheral vessel diseases.

The nails infected with fungi have characteristic symptoms manifested in their appearance. Discoloration is often seen, since nails acquire a yellow colouration, their volume changes and they thicken. In other cases, nails break or fall off and it is not unusual to experience pain when walking with shoes on. If your nails show one or multiple of these changes, contact out clinic and make an appointment immediately. Until then, do not apply any local treatment so that we can collect material from your nails and make an examination and study of the microbiological culture for fungi.

Diagnosis and treatment

The first step is to collect material from the nails for a study. A specialised test takes place, after which the material is cultivated to identify and classify the fungus responsible for the infection. Then, an antifungal diagram is prepared to test the fungus sensitivity to antimycotic drugs. The results of the antifungal table show the appropriate treatment since the preparation (applied locally or orally) to which fungi are susceptible, is already identified.

The next steps are a focused and personalized treatment in combination with laser therapy, inclusion of a photosensitizing agent (if deemed necessary) for increase of the therapeutic effect of the laser and comparison of the process of elimination of damages on the nails.

Combined laser treatment

Treatment of onychomycosis is performed with the long pulse laser Nd: YAG (1,064- nm) in combination with local treatment with or without oral drugs. In laser therapy, energy is targeted selectively to a specific area, and it is safe and tolerable for patients. Multiple “microtherapeutic areas” produced by Nd: YAG laser in nail tissues enable a deeper penetration of antimycotic agents in the nail plate, its bed or matrix. This leads to a transfer of heat to the nail and the fungi are destroyed without damaging surrounding tissue. In combination with phototherapy and local antifungal agent, laser therapy is perfect for patients for whom the administration of drugs is either ineffective or contraindicated.

The procedure has no side effects, there is no recovery period, and it enables patients to resume their daily activities immediately. After treatment, the nails grow normally and are healthy.

How to achieve effective laser treatment

Laser treatment is based on the theory of selective photothermolysis, which, by definition, provides an accurate and effective focus on the lesion without affecting neighbouring areas. Multiple "microtherapeutic areas" produced by the long pulsed laser Nd: YAG (1064 nm) in nail tissues enable a deeper penetration of antimycotic agents in the nail plate, its bed or matrix. This leads to a transfer of heat to the nail and the fungi are destroyed without damaging surrounding tissue.

If nail fungi are not treated, a chronic condition will develop. According to data, the majority of patients believe that the infection is incurable. They do not follow the instructions of their dermatologist, cease treatment before its completion, and the condition worsens and becomes chronic.

Antifungal drugs for local administration are ineffective. Nails are infected again in 16-25% of patients. This happens because the majority of local treatments cannot penetrate deeply in the nail bed and matrix. In addition, oral antifungal drugs are moderately effective and cause side effects.

In the case that a patient suffers from other disease for which drugs need to be taken, the treatment of fungi is complicated since unwanted interactions between medications may occur. Finally, a long and ineffective treatment wears patients out and discourages them, which in most cases leads to its interruption.

To prevent the occurrence of onychomycosis, specialists recommend observing good personal hygiene. Poor hygiene habits can lead to different infections and diseases. Given the increased likelihood of deformation of the nails with a following infection, which is the most common cause of development of onychomycosis, wearing comfortable shoes and avoiding of trauma of the toenail plates are recommended.


Frequently Asked Questions

Two protocols of operation are available – covering the entire nail plate four times with pulses, with the procedures taking place weekly until the growth of a healthy nail, or 400 pulses per thumb toenail and 150 pulses per small toenail, with the procedure taking place monthly.
Immediately after the procedure, pulsation and mild pain which resolve for about 30 minutes, can be felt.

Before and After