Reassessing Laser Treatment As An Alternative Option For Onychomycosis

Could an innovative technology help improve patient outcomes for onychomycosis and increase practice revenue?

The PinPointe^™ FootLaser^® is a Food and Drug Administration (FDA)-cleared system for temporary increase of clear nail in patients with onychomycosis, according to NuvoLase, Inc. The company says the laser passes through the nail without damaging surrounding skin and targets the fungus living in and under the nail. NuvoLase maintains that the PinPointe FootLaser also has none of the potentially harmful side effects of oral antifungal medications.

Richard S. Mendelsohn, DPM, FACFAS, who has used the PinPointe FootLaser since 2008, notes “excellent, consistent results” when patients follow a strict pre- and post-treatment protocol.  

“We have found in our practice that using four to six treatments (one treatment every two to three months, depending on speed of nail growth) over one year is an efficient and successful method of treating the condition,” shares Dr. Mendelsohn, a Fellow of the American College of Foot and Ankle Surgeons.

Paul Gee, DPM has over seven years of experience with using the PinPointe laser in a multispecialty clinic environment. He also echoes the importance of patient participation in the overall treatment process for optimal success. When discussing the laser treatment with patients, Dr. Gee recommends adjunctive therapy after the procedure. This may include a topical nail antifungal, treatment of any tinea pedis and an ultraviolet light shoe sterilizer to avoid regression or recurrence.

“Our practice has a receptive patient population and patients have generally been happy (with the laser procedure),” shares Dr. Gee, who is in private practice in multiple locations in Texas.

The company adds that podiatrists can perform this procedure in the office in approximately 30 minutes. The PinPointe FootLaser system can easily fit into clinical offices due to its portable, compact design and small footprint, notes NuvoLase. The device also features a light, ergonomic handpiece designed for easy handling, according to NuvoLase. The company adds that the clinician can plug the device into a standard electrical outlet and it comes with preset treatment parameters.

Dr. Mendelsohn cites the inherent standardization of settings and minimal adjustments needed within the system as part of his practice’s positive experience.

“We also find that daily calibration of the laser using temperature gradients and routine maintenance contributes to giving us excellent results,” notes Dr. Mendelsohn, who has multiple office locations in Virginia.

An open dialogue with patients regarding expectations is also helpful, adds Dr. Gee. He says overall results depend in part on the severity of the nail one is treating. In some instances, Dr. Gee finds it beneficial to perform a nail avulsion prior to laser treatment in patients with severely thickened fungal nails.
He stresses that patients need to understand that this treatment is most successful when they adhere to pre- and post-procedure physician recommendations.

Dr. Gee relates that some patients will use Health Savings Accounts (HSAs) or similar programs to pay for their laser treatment. Dr. Mendelsohn relates that patients understand that insurance typically does not cover this service. However, in his practice, Dr. Mendelsohn notes he performs the procedure and often has diagnosed other pathologies during that visit. He relates an almost 100 percent conversion from laser patients to practice patients as a result.