Lasers Won't Cure Your Toenail Fungus

I'm often asked by patients if laser therapy is effective in treating nail fungus.
 
The Short Answer:

​Probably not. While laser therapy may improve the appearance of the nail for a short time, data doesn't support the idea that it is effective in resolving a fungal infection. I would not recommend it for most patients. 
 
The Long Answer:  

Nail Fungus (Onychomycosis) is common issue that affects 1 in 10 of us nationwide, likely more than that here in the Pacific Northwest. Something I tell my patients about nail fungus is that it is very easy to get and can be incredibly hard to get rid of, especially if the infection has been present a significant amount of time. There are reasonably effective treatments available depending on the severity, but whenever medicine doesn’t have a quick and highly effective solution for something, that niche is often filled with products that will promise the moon and fail to deliver.  

Laser therapy for onychomycosis involves using focused light beams to heat and attempt to destroy the fungi living under and within the nail. Different types of lasers have been approved by the FDA for the temporary increase of clear nail in fungal nail infections. It’s incredibly important to note: FDA clearance for these lasers is not based on long-term clinical effectiveness, but rather the temporary improvement in the appearance of the nails. 

There’s no shortage of anecdotal success stories and slick marketing campaigns for these lasers. I often have representatives from these companies calling and visiting my office telling me how much money I can make from their device. But when I ask them to provide convincing evidence that the laser actually works to resolve the infection? *crickets*  

When we look at the clinical data, the picture gets a bit clearer. Most of these studies have severe limitations which include: 

-Short follow-up periods: Nail fungus is slow-growing. Many studies report clear nails after 3 or 6 months, but without longer follow-up they are going to miss relapses, and temporary clearance may be misinterpreted as cure. 

-No standardized protocols: There’s a ton of variation in how lasers are used. There are large differences in the type of laser, its wavelength, duration of treatment, and number of sessions across these studies. This inconsistency makes it difficult to compare studies or establish best practices. 
-Lack of direct comparisons to standard treatments: Oral antifungals like terbinafine (Lamisil) along with prescription strength topicals remain our gold standard of treatment. Laser therapy has not convincingly outperformed these medications in head-to-head trials. 

I would challenge any provider that swears this is an effective treatment to publish their data, and any company selling these devices to fund a research study that can help verify what they claim. Strange how we see neither of these happening at a convincing scale, huh? 

For the average patient with toenail fungus, laser treatment is not scientifically supported and probably not a good option. I would go as far to say that this treatment probably should not be recommended by any provider without a serious discussion of its limitations. I have seen too many patients struggling with this diagnosis that have spent hundreds if not thousands of dollars on laser treatments, often without first exhausting actual evidence-based therapy. While some patients may see improvement with laser, results are inconsistent, and recurrence is common. A 2020 Cochrane Review concluded that there is “low to very low certainty evidence” supporting the use of laser therapy for fungal nails. 
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That’s not to say the technology has no application or should never be used. Based on current evidence, someone with nail fungus who, for example, might be going to a wedding and want to wear open toed shoes could potentially benefit from the temporary improvement in appearance. But like with most experimental treatments, I recommend patients first exhaust evidence-backed approaches, and in the case of failure or inability to pursue to those treatments, carefully consider if alternative therapies are worth the money. 
 
If you have nail fungus, or any other foot and ankle pathology that you want treated in an effective way that is supported by rigorous, science backed research, give us a call or schedule an appointment online!