When patients come to Compleet Feet we always do a consultation to grade their presenting fungal nail disease (onychomycosis). This helps us to determine what course of treatment will be most effective for their particular case. The longer the patient has had an infection, the more chronic it is and thus often harder to treat as it could have have deeply imbedded nail plate biofilm.
Biofilm are microscopic films cause by micro-organisms, which can trap dormant dermaphytic spores, which are then resistant to anti-fungal treatments drug or laser. It is hard as podiatrists for us to know if a patient has a fungal biofilm as it was in the case of KC. He presented for treatment for his fungal nail disease in 2014; “I have had it for years and can’t get rid of it…..it seems to get better then comes back!”. Unfortunately, KC’s wife had been cross-infected and needed her infection treated too.
We treated the infection initially with a course of thermal Nd:YAG laser sessions, but he found the treatment too painful so we switched to Lunula ‘cold’ laser. After the course of treatment was completed we took a culture and it came back negative for infection. KC was advised to be vigilant keep on with the good post care treatment protocols we issued him with to minimise re-infection, but sadly he was back a year later with obvious signs on infection. Not as bad as before, but it needed to be stopped in it’s tracks so we advised Clearanail Microdrill therapy.
Clearanail microdrill therapy is painlessly introducing multiple minute holes through the plate down to the nail bed. The holes are placed at the edges of the invading infection. This allows for a topical antifungal drug, Terbinafine Hydrochloride to be absorbed into the nail plate to directly target the infection. The terbinafine builds up in the treated area to weaken and eradicate fungal dermaphytes.
Clearanail microdrill therapy is painlessly introducing multiple minute holes through the plate down to the nail bed. The holes are placed at the edges of the invading infection. This allows for a topical antifungal drug, Terbinafine Hydrochloride to be absorbed into the nail plate to directly target the infection. The terbinafine builds up in the treated area to weaken and eradicate fungal dermaphytes. This all makes sense, but if there is the presence of a biofilm the drug won’t work on trapped dermaphytes or spores. Time wasted, and sadly it was precious time wasted for KC. Treatments were failing. despite us doing our bit and the patient adhering to all aftercare advice. The trapped and imbedded spores would become active and colonise at a later point in time. As the infection was not clearing the nail plate was becoming distorted and KC developed painful ingrowing toenails.
Another course of laser fungal nail treatment was not considered the best treatment option, but removing the infected nails to remove any presence of a biofilm was deemed to be best practice. Even though this patient was needle phobic he agreed to this option and was pleasantly suprised how easy and comfortable it was. The nail beds healed up very quickly within a week and he then commenced a course of just 4 Lunula laser sessions to eradicate any deep lying infection in the nail folds, re-condition the nail bed and accelerate quicker stronger nail growth.
KC returned to the clinic just over 6 months later and he had full grown healthy infection free nail plates. Considering how long totally removed nail plates take to regrow this was amazingly quick. This was all down to the Lunula which increases nutrition and circulation to the big toes. Our patient was extremely happy and proudly wearing sandals in public! Even better his wife’s nails were also infection free, as the cross infection cycle had been broken. They now could happily play footsie under the table!