laser therapy to treat nail fungus

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  1. 1. Marco Ucciferri,DPM, FACFAS Laser Treatment of Nail Fungus
  2. 2. 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):497-519 2. Rich P et al. Semin Cutan Med Surg. 2013;32(2 Suppl 1):S5-8 3. Pariser D. Semin Cutan Med Surg. 2013;32(2 Suppl 1):S1 For Presentation Purposes Only. Not To Be Copied Or Left With Health Care Professionals.
  3. 3. T. rubrum Is the Most Common Cause 1. http://phil.cdc.gov/phil ID#11009; ID#14588 2. 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 causative organisms2: Other Trichophyton spp Microsporum canis Epidermophyton floccosum Acremonium spp Fusarium spp Scopulariopsis spp Scytalidium spp Aspergillus spp Candida spp For Presentation Purposes Only. Not To Be Copied Or Left With Health Care Professionals.
  4. 4. 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: 263274 2. Hay RJ, Baran R. JAAD. 2011; 65(6): 12191227 1972 Totally dystrophic onychomycosis (TDO)1981 Endonyx onychomycosis1999 Mixed pattern onychomycosis (MPO) Secondary onychomycosis 2011 For Presentation Purposes Only. Not To Be Copied Or Left With Health Care Professionals.
  5. 5. 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 For Presentation Purposes Only. Not To Be Copied Or Left With Health Care Professionals.
  6. 6. 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):S5-8 2. Westerberg DP, Voyack MJ.et al. Am Fam Physician. 2013;88(11):762-70 For Presentation Purposes Only. Not To Be Copied Or Left With Health Care Professionals.
  7. 7. Predisposing Factors Gender (male) Age Smoking 1. Thomas j et al. J Clin Pharm Ther. 2010;35(5):497-519 2. 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 For Presentation Purposes Only. Not To Be Copied Or Left With Health Care Professionals.
  8. 8. 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 For Presentation Purposes Only. Not To Be Copied Or Left With Health Care Professionals.
  9. 9. It is an infectiona 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):S1 2. Thomas J et al. J Clin Pharm Ther. 2010;35(5):497-519 For Presentation Purposes Only. Not To Be Copied Or Left With Health Care Professionals.
  10. 10. 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 For Presentation Purposes Only. Not To Be Copied Or Left With Health Care Professionals.
  11. 11. 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 For Presentation Purposes Only. Not To Be Copied Or Left With Health Care Professionals.
  12. 12. Application to site of infection No known drug interactions at therapeutic concentrations No liver monitoring needed Characteristics of Topical Antifungal Therapy For Presentation Purposes Only. Not To Be Copied Or Left With Health Care Professionals.
  13. 13. Laser Therapy Q-clear Procedure Time to improve Cost
  14. 14. 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 For Presentation Purposes Only. Not To Be Copied Or Left With Health Care Professionals.

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