Lunula Laser Fungal Nail Audit 2016/17

Lunula Laser Fungal Nail Audit 2016/17

Compleet Feet have just completed their 2016/17 audit for Lunula laser ‘clinical cure’ rates. We base our audit on all culture results taken over a 12-month period. It is our protocol to take a diagnostic culture at the end of a Lunula course to determine whether there is presenting negative or positive fungal activity. Our latest audit demonstrated an 84 -87% success rate.

Using cultures as a method of auditing is not an exact science, but it is the best way we can demonstrate that at the end of a Lunula course, the initial presenting fungal activity has ceased. We term this the ‘clinical cure’. A true ‘treatment cure’ is when the infected nail has totally grown out. It is often difficult to audit these long-term outcomes as patients tend to be happy with their results and do not re-book or keep us up to date. We can only assume they are infection free. We do urge patients to contact the clinic if they exhibit any signs of re-infection.

We use enriched dermaphyte culture mediums. These are specifically sensitive to presence of Trichophyton Rubrum and Trichophyton Mentagropytes, which are the 2 main dermaphytes affecting human keratin. In controlled conditions the incubation period is 7-14 days. Culture mediums turn red if there is fungal activity. We call this a positive result. If there is strong fungal activity there will be fluffy growth around the nail samples taken. Nail samples are taken at the proximal edge of the infection as deep down into the nail plate as we can reach. A Clearanail micro-drill bit is sometimes used to penetrate through the nail plate. This enables reaching the source of nail plate/ bed infection to get more accurate results. The cultures are very sensitive. Care must be taken to not contaminate the culture medium.

Of the positive cultures taken demonstrating fungal activity, some turned just slightly red, but as a clinic we view these with suspicion and are therefore over-cautious and advise further treatment e.g. additional Lunula sessions. It is our rationale in the first instance to take diagnostic cultures to not leave anything to chance. Time is of the essence. Dermaphytes can re-colonise very quickly. Some clinics do not perform cultures and simply wait 4-6 weeks to visually observe new clear nail growth. This is risky. It is also our protocol to review patients at 4-6 weeks.

The practice of taking cultures is not 100% effective. 3% of the 16% positive cultures were inconclusive/contaminated by a saphrophyte. A saphrophyte is naturally occurring mould causing a decomposition reaction. These could be caused by dirt/soil etc. located on the nail plate. These cultures had to be re-done and proved to be negative, so in theory the success rate is 87%.

Included in the audit were a couple of patients who had repeat cultures taken, which unfortunately kept coming back positive. The reason for the failure of their treatment is multi-factorial e.g. immuno-compromised issues, re-recurring Athlete’s Foot, yeast issues, long history of onychomycosis with entrenched nail plate infection and thickening. These are high grade infections which are sometimes a little more problematic to treat.

In recalcitrant cases, we undertake a re-evaluation of the patient’s treatment programme and try to identify why the Lunula has failed. If a patient has stringently followed our post-care protocols e.g. paying attention to eradicating fungal spores etc. and nothing seems to be working, we can offer a more invasive surgical solution to really combat the problem. Often it is a case of just one or 2 nails not responding which causes the positive cultures. By removing these troublesome nails under local anaesthetic, followed up post-operatively with a course of 4 Lunula sessions spaced apart at weekly intervals, we can accelerate quick healthy new nail growth. Thickened nails have retarded out-growing nail growth, whereas Lunula treated nails grow out very quickly. This course of action may sound very drastic, but it is highly effective and not as gruesome or as painful as patients fear it would be.

In summary, we are pleased with our success rate for treating all grades of fungal infected nail infections. It would be great to get a 90% success rate, but in comparison to the effectiveness of using topicals and taking high risk oral medication, the Lunula provides a far more effective and safer treatment option.  It must be remembered having Lunula laser treatment it is part of a process. If patients do not adhere to our advice and do not do their bit, then the success of their treatment is reduced. We work hard to convey this; to facilitate patients to get optimal results to mitigate the disappointing failure rates.