laser therapy to treat nail fungus

14
Marco Ucciferri,DPM, FACFAS Laser Treatment of Nail Fungus

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Page 1: Laser Therapy To Treat Nail Fungus

Marco Ucciferri,DPM, FACFAS

Laser Treatment of Nail Fungus

Page 2: Laser Therapy To Treat Nail Fungus

• Fungal infection of the nail unit: nail plate, nail bed, and periungual tissue1,2

– Causes discoloration, thickening, and separation from nail bed2

– May lead to permanent damage of nail plate and attachments3

• May be associated with significant clinical issues3

• Progressive condition that warrants intervention3

Toenail Onychomycosis

1. Thomas J et al. J Clin Pharm Ther. 2010;35(5):497-5192. Rich P et al. Semin Cutan Med Surg. 2013;32(2 Suppl 1):S5-83. Pariser D. Semin Cutan Med Surg. 2013;32(2 Suppl 1):S1

For Presentation Purposes Only. Not To Be

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Page 3: Laser Therapy To Treat Nail Fungus

T. rubrum Is the Most Common Cause

1. http://phil.cdc.gov/phil ID#11009; ID#145882. Scher RK et al. Semin Cutan Med Surg. 2013 ;32(2 Suppl 1):S2-4

T. rubrum is responsible for

90% of onychomycosis2

Trichophyton rubrum1 Less common causativeorganisms2:

• Other Trichophyton spp

• Microsporum canis

• Epidermophyton floccosum

• Acremonium spp

• Fusarium spp

• Scopulariopsis spp

• Scytalidium spp

• Aspergillus spp

• Candida spp

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Page 4: Laser Therapy To Treat Nail Fungus

• ZAIAS Classification

– Distal (lateral) subungual onychomycosis (DSO/DLSO)

– White superficial onychomycosis (WSO)

– Proximal subungual onychomycosis (PSO)

– Candida onychomycosis

Clinical Presentation & Classification

1. Zaias, N. Onychomycosis. Arch Dermatol. 1972; 105: 263–2742. Hay RJ, Baran R. JAAD. 2011; 65(6): 1219–1227

1972

– Totally dystrophic onychomycosis (TDO)1981

– Endonyx onychomycosis1999– Mixed pattern onychomycosis (MPO)

– Secondary onychomycosis

2011

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Page 5: Laser Therapy To Treat Nail Fungus

Diagnosis

Onychomycosis?

Psoriasis! Looks like onychomycosis with distal thickening of the nail with

some onycholysis, but the patient has psoriasis AND history of nail trauma

which might have koebnerized the nail.

Courtesy of B. Elewski, Professor of Dermatology, UAB

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Page 6: Laser Therapy To Treat Nail Fungus

Diagnosis

Differential diagnosis (adults):1

• Psoriasis

• Nail trauma

• Exogenous substances (eg. Nail polish, medications)

• Lichen Planus

• Neoplasms

• Infection (bacterial)

• Aging

Clinical Diagnosis:1

• Physical examination

• Concomitant tinea pedis

• Family history

• Age

Lab confirmation:1

• KOH, culture, PAS, PCR1,2

1. Rich P et al. Semin Cutan Med Surg. 2013;32(2 Suppl 1):S5-82. Westerberg DP, Voyack MJ.et al. Am Fam Physician. 2013;88(11):762-70

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Page 7: Laser Therapy To Treat Nail Fungus

Predisposing Factors

• Gender (male)

• Age

• Smoking

1. Thomas j et al. J Clin Pharm Ther. 2010;35(5):497-5192. Scher RK et al. Semin Cutan Med Surg. 2013 ;32(2 Suppl 1):S2-S4

• Occlusive shoes

• Public sports facilities/gyms

• Nail salons

• Poor foot hygiene

• Concurrent fungal infection (eg. Tinea pedis)

• Diabetes/Peripheral vascular disease

• Nail trauma

• Immune deficiency

• Genetics

• Humid and warm

Demographics1,2 Lifestyle/ hygiene1,2

Medical Condition1,2

Climatic Conditions1,2

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Page 8: Laser Therapy To Treat Nail Fungus

Demographics of Those Seeking Rx Treatment*

1. NDTI data, September 2013

63% of patients are less than 55 years old1

0%

5%

10%

15%

20%

25%

< 20 20-24 25-34 35-44 45-54 55-64 ≥65

MALE PATIENTS

49.1%

FEMALE PATIENTS

50.9%

50% of patients female/male1

Treatment seekers* are balanced male vs. female, and across diverse age groups

* Data refers to Lamisil users

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Page 9: Laser Therapy To Treat Nail Fungus

• It is an infection…a fungal infection

• Progressive condition1

• Permanent damage to nail plate and attachments1

• Transmission to other body parts and/or other people1,2

Toenail Onychomycosis:Importance of Treatment

1. Pariser D. Semin Cutan Med Surg. 2013;32(2 Suppl 1):S12. Thomas J et al. J Clin Pharm Ther. 2010;35(5):497-519

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Page 10: Laser Therapy To Treat Nail Fungus

Toenail Onychomycosis:Goals of Treatment

Eliminate causative agent1*

Elewski B et al. Semin Cutan Med Surg. 2013 ;32(2 Suppl 1):S9-12

Restore appearance of toenail(s)1*

Pharmacological: Physiological (Nail growth):

* Results may vary

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Page 11: Laser Therapy To Treat Nail Fungus

Oral Rx Products

• Itraconazole capsules and tablets

• Terbinafine tablets

Topical Rx Products

• Efinaconazole topical solution

• Tavaborole topical solution

• Ciclopirox topical solution

OTC Products

Homeopathic Products

Laser Treatment

Toenail Onychomycosis: Current “Treatment” Options

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Page 12: Laser Therapy To Treat Nail Fungus

• Application to site of infection

• No known drug interactions at therapeutic concentrations

• No liver monitoring needed

Characteristics of Topical Antifungal Therapy

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Page 13: Laser Therapy To Treat Nail Fungus

Laser Therapy

• Q-clear

• Procedure

• Time to improve

• Cost

Page 14: Laser Therapy To Treat Nail Fungus

Summary

• T. rubrum is the most common cause, responsible for

90% of cases

• A frequent and increasing problem

• Both females and males, and patients of all ages seek

treatment

• A significant clinical burden – warrants treatment

• Treatment goals: elimination of fungus & improved

toenail(s) appearance

• Effective topical therapy may be appropriate for

treatment of toenail onychomycosis

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