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Welcome to Dr. Bob's Anti-Fungal Blog

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5 Steps to Achieve Successful Anti-fungal Laser Treatment


1. Proper Fungus Diagnosis anti fungal laser

Before you spend upward of $1000 on an Anti-Fungal Laser Treatment make sure you actually have Onychomycosis (toenail fungus). There are other nail disorders that have the same symptoms as Toenail Fungus.

Three ways your doctor can diagnose you with Toenail Fungus

  • PAS (Periodic Acid Schiff)
  • KOH (Potassium Hydroxide Preparation)
  • Fungal Culture

Note that there is a relative high rate of false negatives with these fungal diagnosis tests usually due to inadequate specimens.

A good specimen is obtained as far back on the nail including the debris beneath the toenail.

Other conditions that resemble Onychomycosis (nail fungus).

  • Psoriasis
  • Onychodystrophy – a nail injury from either trauma or prior surgery.
  • Lichin Planus – a chronic skin disorder
  • Eczematous Dermatitides – a persistent skin condition that can be caused by contact with irritants.
  • Alopecia Areata – a recurring, non-scaring type of hair loss that can affect various parts of the body.

2. Inadequate Treatment 

Only treating the nails with one fungus laser treatment is inadequate

It is becoming evident that laser therapy for Onychomycosis requires more than one treatment.

  • It is recommended that each fungal laser session consist of two or three treatments for each infected nail.
  • Typically multiple laser treatments spaced four to six weeks apart are required for best results.


3. Debride and Debulk the nails before Fungus Laser Therapy

  • Cutting the nails as short and as thin as possible prior to laser therapy is very helpful for quicker and better results.
  • You can use a course nail file to file off the top of the nail and get rid of any excess debris


4. Treat chronic Athlete’s Foot (Tinea Pedis) 

Foot Fungus is often the predecessor to Onychomycosis. If fungus is left on the skin, even if the toenails are cleared by laser treatments, the skin fungus will more than likely infect the toenails once again.

Treatment options for chronic foot fungus (Tinea Pedis)

  • Topical anti-fungal creams used for at least four weeks
  • Oral anti fungal pills (Lamisil or Sporanox) – have the potential to cause liver problems. Doctors recommend liver tests in conjunction with taking anti fungal pills


5. Control excessive foot sweating (Hyperhidrosis)

If you do not control excessive sweating it can lead to higher recurrence rates. Fungus likes a warm, moist environment; sweaty feet in closed shoes are an ideal condition for fungus to take over and spread.

How to control sweaty feet

  • 90% of patients with sweaty feet (Hyperhidrosis) can control the issue with an antiperspirant spray or foot powder. Cover the tops and bottoms of the toes, as well as the sole of the foot. Make sure the foot in dry before dressing.
  • About 5% of patients with Hyperhidrosis require a prescription drying medication, such as Drysol.
  • About 3% of patients with Hyperhidrosis require either Botox® injections or iontophoresis.
  • About 2% of patients with Hyperhidrosis require an oral medication like Robinul (Glycopyrrolate).

*Bonus Tip* 

Doctors recommend using a topical nail anti fungal in between laser treatments. PediMD Nail Treatment System is an oil-based topical anti fungal medication; therefore it is able to actually penetrate the nail unlike other nail lacquers. Using PediMD in conjunction with Anti-fungal Laser Treatment will:

  1. Promote the growth of a new healthy nail
  2. Clear any fungus that the Laser may have missed
  3. Prevent future fungal infections from developing on the skin
  4. Allow the patient to continue to use nail polish over the over the treatment

Excerpts from this article were taken from Dr. Patrick DeHeer's article "5 Crucial Mistakes to Avoid With Toenail Laser Treatment" Dr. DeHeer offers Laser Toenail Fungus therapy in his Indiana based practice and has had over 20 years experience treating Toenail Fungus.           




This is a very good overview of the process, with some great added tidbits. You summed up the dialogue we have with our patients very well. Keep the articles coming!
Posted @ Thursday, June 30, 2011 3:53 PM by Stephen Benson, DPM
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