Recently there are several companies claimed their ND:YAG lasers (either Q-switched or long pulsed) could be used to treat onychomycosis with at least 88% successful rate. I wonder if anyone here had experience in toenail laser treatment? Any comments or thoughts are appreciated .

yes, I have used the fotona long pulsed xp max to treat onychomycosis. It is quite painful, but it works quite well.
So far I have treated about 10 of them with great success. I can get good result in 2 treatments.
The power has to be high, short pulse width in order to get the job done

yes, I agree the q-switched is good option to go with too.
For long pulse, it will take 2 x passes, which takes about 30 seconds for the whole treatment.
I charged $250 for such treatment.

I have recently completed a one week "trial" with the machine the Podiatrist is selling. It actually is painless on the toenails at the 7 J/cm2 setting and a pulse rate of 4 Hz. I took some clinical photos and will follow the toenails closely. I am also quite skeptical of any laser being used to treat onychomycosis that hasn't had a double-blinded clinical trial.

Just an FYI, the PinPointe Laser has today received FDA approval for the treatment of onychomycosis. You can read about it here:
http://www.sys-con.com/node/1577913

@ chris qld , yes 1 or 10 toes still cost 250$. I dont charge more for that as it takes less than 5 min to do all if required.
I see good result in 1 treatment.
I schedule a follow up visits at 3 months, 6 months , 9 months at 25$ per appointment and at the same time, I take pictures.
my setting starts at 40j, 30ms pulse width and i use 4mm spot, then 50j, 15-20ms 4mm. with zimmer 5.
my endpoint is : seeing slight tears from my patients, and this usually takes 2 -3 passes.

I have both long pulsed and short pulsed 1064 ND YAG laser in my practice. Sciton 1064 Long pulsed ND YAG and Fotona Q switched 1064 ND YAG. Would my lasers be adquate in treating onychomycosis? I have a large group of hepatitis B patients who are poor candidate for oral sporonox treatment. Topical Loceryl treatment progress is too slow in some patients. I'm thinking about starting treatment at 35J 0.5mm 16Hz for long pulsed ND YAg and 3mm 6J 10Hz for Q switched ND YAG.

Q-Clear by light Age which is a Q-Switched ND YAG 1064nm 532nm is the best for onychomycosis Pulse energy Variable up to 800mj
Fluence Vairable 2- 12 j/cm
Pulse rate 1-5 HZ
Spot Size 2.5mm 3.5mm 5mm 6mm

Chris qid:
Thanks for sharing your experience of treating onychomycosis with Q switched ND YAG laser. I was going to start experimenting with this idea but was too busy to start my study. Can you share your treatment parameter with the q switched ND YAG laser? What brand of laser platform are you using? My podiatrist friends have not heard of laser treatment for onychomycosis. Guess this really is something new.

I do not recall the fluences used but I do recall reading that this is a slow process and requires up to a year to note a real change. It also may require a second treatment a few months out. The time is due to the nail growth and to have a good clean nail requires a total nail changover. Also it is important that the patient take measures to aviod the conditions that lead up to the fungal infection and it may return anyhow.

I have found to the Q-Clear by light Age to be almost painless. We have treated over thousand patients with 30 doctors involved. Results are very good. It is very hard to energy parameters between the Q-Clear Q-Switch lasers. and long pulse lasers. They are two different animals.

September 28, 2011- Light Age, Inc., a Somerset, NJ based private developer and manufacture of laser products, has received US FDA marketing approval for its Q-Clear™ laser systems for the treatment of onychomycosis. The only Q-Switch YAG laser to be FDA approved for onychomycosis.

The fact that a European study with YAG 1064 using 35 msec pulse width showed 100% clearance means that there is not one right way to do this at present. Q switched, short pulse, long pulse, ALL have produced some degree of clearance.

Has anyone figured out what the FDA has actually approved? If the Q switched laser has been approved for this that's one, but there's also FDA approval for non-Q switched. Does anyone know whether the FDA has stipulated long vs short pulse (or vice versa) for treating tinea unguium?

Both Cutera and Aerolase have done their studies with short (< 1msec) pulsed YAG.

Love Light Age - I own several of their systems including the Q-Clear. The Q-Clear is a passive Q-switched laser system that works surprising well on nail fungus. The fluence stated above is a bit light. I like to treat a bit more aggressively at >12 J/cm^2. I use a "paint brush" technique - providing two to three passes. Usually just one treatment is all it takes. To the practitioner looking to see immediate results - don't be ridiculous! You need to advise clients to wait at least three months. At that time, I normally expect to see 50% new nail growth largely free of OM. 6 months and we should see 100% new nail growth free from OM. Of course these time frames can vary. No cooling is needed and client tolerance is excellent. We provide free touch ups for one year post treatment. I've never had a client need more than two treatments.

The Q-Clear also works quite well for tattoo removal - or a least for many ink colors.

To the individual thinking about using an IPL - good luck! I would certainly warm your patients about risk of the nail falling off due to blistering!!

On a Sciton 1064nm use 20J/cm2 0.3ms with no topical cooling, just blow cold air from a Zimmer Chiller on treated area while making 3 passes (horizontally, vertically, horizontally) with a paintbrush technique over each affected nail will provide good results with a single treament. It hurts but is tolerable without anlagesia. Take before and after pictures!!!! Follow up with patient 4 mos later to assess effectiveness. Should see at least 1cm of healthy growth at that follow up visit. The portion of nail distorted by the fungus should be growing out and being replaced by healthy looking nail. The nail will not look completely normal until a year after treatment if it was successful. $300 per single nail or $500 for 2 or more nails on an extremity. Thicker nails may need to be surgically removed and have the nail bed and remaining nail base treated. No guarantee that it works for everyone. 88% effectiveness proven with other 1064nm lasers (Pinpoint brand) have been documented.

Has anyone tried to treat onychomycosis laser Smoothbeam ??(wave-length 1450 nm)....

Nail debridement was performed on the toenails that were significantly thickened. I was told that this helped to ensure satisfactory results (and seemed to make sense to me as well). Post-procedure preventative measures (topical anti-fungal creams and disinfecting sprays for footwear) similarly are good ideas

Is this another craze? Has anyone actually seen significant improvements using laser as a treatment for onychomycosis?

I have a Cynosure Elite laser with a 1064nm wavelength, I'd like to treat onychomycosis. Any suggestions on settings?

I have treated myself with the Aerolase 1064 .6 msec pulse .I had fungus on all 10 toes . Results after 2 treatments have Been excellent. Aerolase has the power to penetrate thick nails that Qclear and Pinpointe do not have.
With Aerolase short pulse we treat skin types IV to VI for hair, acne, hyper pigmentation etc . Their laser offers incredible versatility.

What did you use for the Joules?

1 pass , 5mmk
Lens,48 J/cm2
2nd pass 2mm lens, 255J/cm2

An Argentinian company called HEALIGHT CORP developed a laser device using 1450nm (They also have a 1064nm uni). Both units have CE and have already applied for FDA as far as I know.

I have been using this system (I am located in Brazil now) for the last 4 months with excellent results for light to severe onychomicosis. The system is unique because its portable, battery operated which allows me to take the system with me for remote treatments and its protocol indicates that the laser system sets its own paramenters and treats the toenails by continuously measuring how temp evolves on the nail bed and sustains it for 30 sec at a controlled and stable temp.

Most moderate to severe fungui infections cleared after the second reatment.

Looking for parameters & # of sessions needed, spaced how far apart? for GentleYag for Onychomycosis. Any pre-treatment requirements ie.Nail debridement, post care..topical creams etc?

Anything will help. Thanks