Lighting the Way to Beautiful, Healthy Toenails

Over 105 dermatologists from Australia and around the world are sharing information about the latest skin care breakthroughs and developments at the 46th Annual Scientific Meeting of the Australasian College of Dermatologists, being held at Sydney Convention Centre from 19-22 May.

Professor Yasushi Suga presents his findings

Professional Beauty Magazine caught up with Professor Yasushi Suga, MD, PhD who flew in from the Juntendo University, Urayasu City, Japan to address a Cutera-sponsored breakfast meeting and share his research in treating onychomycosis (toenail fungus) and recalcitrant warts with a long pulsed Nd:Yag laser.

Toenail fungus affects ten per cent of the population worldwide and up to 40 per cent of people over the age of 60. It can easily be transferred by contact between skin and nails – in a variety of places from nail bars (including in the nail polish), showers, gymnasiums… and even being fitted for a new pair of shoes if the person trying them on before you had an infection.

Traditional treatments include topical nail paints and oral medication. According to Professor Suga, these are not always effective or in the case of oral medications not suitable for people with particular health issues, especially liver related conditions.

Professor Suga summarised his study for treating recalcitrant cases of toenail onychomycoses with a long-pulsed Nd:YAG (1064nm) laser as follows:
“We performed a clinical trial using the following parameters 14J/cm2, 0.3msec ,5hertz, a 5 mm spot diameter. Thirteen subjects (nine female, four male) with 37 affected toenails received one to three treatments every four to eight weeks. All the subjects had recalcitrant cases despite the internal use of Terbinafine and/or Itraconazole. Treatments were well tolerated by all subjects and there were no adverse events.

"Of the 37 toenails treated, 30 (81 per cent) had "moderate" to "complete" clearance at an average of 16 weeks post-final treatment with follow-up observation at 24 weeks. Nineteen toenails (51 per cent) were completely clear and all tested negative for fungal infection on direct microscopic analysis. No adverse events were reported in any of our cases who received the laser treatment.

“Our preliminary results show that this treatment modality is safe and effective, and the procedure can be performed in outpatient clinics. However, additional studies are needed to more fully assess the clinical benefits as well as optimise the treatment protocol and parameters.”

Professor Yasushi Suga (centre) with Cutera team at the Annual Scientific Meeting of the Australasian College of Dermatologists

We asked Professor Suga the following questions:

Why is the treatment so effective?
Since the treatment is fairly new, its precise mechanisms of action are still unknown. However, the effectiveness of this treatment is thought to be attributable largely to “heat response” induced by the Nd:YAG laser. Laser may damage fungi by heat and by reducing moisture in the nail plate. In addition, thermal response may enhance nail growth by promoting the healing of onychomycosis.

How can these treatments help patients with toenail fungus?
This laser treatment raises the possibility of being able to treat nail onychomycosis in patients who don’t have any other treatment options, such as 1) those who continuously received oral antifungal agents in the past but did not show sufficient responses to these treatments, 2) those who haven’t been able to receive oral antifungal agents due to chronic conditions or potential drug interactions with other oral medications they are currently taking or 3) those who are pregnant or nursing.

How long have you been researching this breakthrough treatment?
In fact, it was already reported in Japan in 1985 by Ueda et al. that the heating effect of CO2 laser beams can treat tinea infections and tinea unguium. It has recently been found that the non-contact mode of the YAG laser can improve the condition of tinea unguium through the application of low fluence laser beams over the entire nail plate.

Our group has found that Cutera’s YAG lasers called “Laser Genesis” are especially easy to use for this purpose.

What should consumers look for when considering laser treatment for onychomycosis?
“Heat reactions” of Nd:YAG laser may enhance nail growth or metabolism, promoting the healing of onychomycosis. I recommend those patients who had poor peripheral circulation in the toes, which slowed toenail growth, hampering proper healing of the onychomycosis.

We will cover this issue in more depth in the July/August issue of Professional Beauty Magazine, including an interview with Podiatrist, Chris Gardner, www.waverleypodiatry.com.au

For more information on Cutera’s GenesisPlus, contact: Phil Schramm, national manager, Australia & New Zealand pschramm@cutera.com, mobile: 0409 470 692.

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