Fungal Nail Treatment

Compleet Fungal and Damaged Nail Treatments

Compleet Feet have been successfully treating the most difficult cases of fungal nail infections for finger and toenails since 2011. Fungal nail infections are considered by dermatologists and podiatrists as one of the most difficult and taxing nail pathologies to treat.

We were one of the first UK podiatry clinics using laser technology to treat fungal nails, and the very first in Hampshire. We have extensive knowledge and expertise in this field of podiatric medicine. We offer many results driven solutions from simple conservative methods using topicals and Clearanail through to more hi-tech methods using laser technology which can be combined with nail surgery for the most difficult of cases.

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Clearanail

Clearanail is a relatively new fungal nail treatment solution. Not to be confused with Curanail topical treatment.

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Lunula ‘Cold’ Laser

The Erchonia Lunula ‘Cold’ laser light therapy is most advanced, researched and clinically proven treatment for all fungal nail infections.

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Onychomycosis, also known as tinea unguium, is an infectious fungal infection of the nail. This condition can affect toenails or fingernails (Tinea manuum), but toenail infections are particularly common. Recent studies reveal approximately 20- 30% of the population have at any one time fungal infected nails. Incidence rates increase considerably with age with weakening immunity. Children are less susceptible to infection.

It is the most common disease of the nails and constitutes about half of all nail abnormalities and can be very hard to treat. It can be identified by thickened, discoloured toenails that become brittle, painful and loose. It retards nail growth and destroys nail plate structures.

A healthy skin has an acidic pH 4.5 which keeps in check small amounts of fungus found all over the body. If the skin becomes damaged or compromised due to poor health then fungus can start to colonise in dark, warm, moist areas like the groin, armpits and feet. Feet are a prime target as  conditions are ideal when wearing socks and occlusive footwear. An Athletes Foot (Ring Worm) condition can develop. This is highly infectious and can be transferred into the nails if the nail plate’s structure is damaged or  cross-infect from others in communal areas, during pedicures, nail bars or simply trying on shoes.

The majority of onychomycosis infections are caused by parasitic dermatophytes that are specific to humans. They are closely related to fungus. There are 2 common dermatophytes:

  • Trichophyton rubrum
  • Trichophyton mentagrophytes

Onychomycosis can also be a mixed infection involving non-dermatophyte fungi such as moulds and yeast. In one study, the causative fungal agents were found to be 68% fungus, 29% yeasts and 3% moulds.  (Bayer)

It is the fungal spores that are the real cause of infections spreading. One infected shed skin cell contains 1000s of microscopic spores which can live on a dry surface for approximately 20 months and on damp surfaces up to 50 months!

  • A pre-disposing Athlete’s foot infection
  • Damage to a nail plate e.g. shoe pressure micro-trauma
  • Sporting activities e.g. running
  • Watersports e.g. swimming
  • Poorly sanitised pedicure instruments in nail bars
  • UV nail gels/ nail varnish left on for long durations
  • Acetone nail varnish removers; damage nail plate
  • Living with infected individuals
  • Diabetes
  • Compromised immune conditions
  • Bowel conditions e.g. increased levels of candida albicans
  • Drug therapies e.g. chemotherapy
  • Over washing feet/ perfumed washing products

There are five primary types of fungal nail infection with Distal Lateral Subungual Onychomycosis (DLSO), representing 80-90% of infections. It is characterised by infection of the nail bed. Fungal infections are harboured in the nail plate layer just above the nail bed.

Fungal infections can progress very slowly in younger and healthier individuals and exponentially increase with age. Initially there may be a small insignificant disruption of the white free edge of the nail; a streak that progresses inwards or a white patch, flecks on the top of the nail plate which are noticed after removing nail varnish. These get more pronounced.

General Signs of Onychomycosis:

  • Thickened nail
  • Crumbly or brittle nail
  • Slow nail growth, growing upwards, but not outwards
  • Nail distorted in shape
  • Nail with no lustre or shine
  • Streaks or patches increasing in size
  • A white, yellow or brown coloured nail, caused by debris build up

Redness and swelling next to the nail (possibly pus) could also be an indication. This a secondary bacterial infection caused by the presence of dermaphytes.

It is very important to diagnose if the presenting nail has a fungal nail infection or there is another cause:

  • Bacterial infection especially Pseudomonas aeruginosa, which turns the nail black or green
  • Psoriasis
  • Eczema or dermatitis
  • Lichen planus
  • Viral warts
  • Onycholysis (nail plate lifting, splitting)
  • Onychogryphosis (nail thickening and scaling under the nail), common in the elderly

At Compleet Feet we will always undertake a thorough diagnostic consultation to determine whether there is a fungal infection present. If we are not sure we will take a specimen culture test.

Most major medical insurance companies and GPs consider onychomycosis to be a cosmetic condition, but it should be considered as a more serious dermatological condition. It can cause sufferers huge psychological stress. Onychomycosis is a destructive disease which can permanently damage nail beds, distorts and thicken nail plates leading to pain and discomfort. It is very infectious leading to multiple infected nails. Suffers become more prone to ingrowing toenails and secondary bacterial infections. Bacterial infections can lead to cellulitis or bone infection. Although, this is not common this presents a concern if an individual is immune-compromised, has diabetes or poor peripheral circulation it is thus important to treat fungal nail infections or at least control the condition to reduce unwanted complications.

Effect on quality of life % of patients with Onychomycosis
Nail-trimming problems                       76
Embarrassment                       74
Pain                       48
Nail pressure                       40
Discomfort wearing shoes                       38
Dexterity reduced e.g. ability to pick up small objects (fingernail involvement)                       41

Information from a study by Bayer

Currently there is not one treatment that can actually eradicate a fungal infection in one treatment other than to actually surgically remove the nail plate, but the  remaining spores in the nail fold and bed must be treated or else new nail will grow back infected. Treating fungal nail infections is a process whereby the dermaphytes environment is altered to become unideal for them to thrive and colonise. Infective spores must be treated as seriously as the actual dermaphytes in the nail plate to optimise any treatment programme otherwise  risk of reinfection is very high.

  • Topical proprietary anti-fungal agents
  • pH modifying home-remedies
  • Homeopathic
  • Clearanail Micro-penetration
  • Lunula laser
  • Nail surgery
  • Oral anti-fungal medication

Topical treatments are usually applied as a lacquer to the surface of the nail plate. Their effectiveness is poor for medium to high grade infections, but have some benefit when treating new infections affecting the free edge of the nail and can help to control some infections as part of a podiatry treatment programme. The main reason why they have reduced efficacy on badly infected nails is that they simply cannot penetrate the hard keratin of the plate to reach source of infection. Think of a nail plate being made up of many layers like plywood. The infection is  harboured in the bottom layer near to the nail bed. Often valuable time is lost whilst individuals try to treat their infections with topicals, having spread further into the plate.

  • Tea Tree products have been recommended as an alternative treatment for fungal nail infections for many years. There is no clinical evidence to support their effectiveness other than to have a mild antimicrobial action and to be applied as an astringent for hygiene purposes.
  • pH modulating agents e.g. vinegar and Vicks Vapour rub. The aim of these products is to change the skin’s pH from alkaline to acidic. Fungus does not like an acidic environment. There is little clinical evidence to support changing PH can inhibit fungal dermaphyte activity, but can in effect make it worse, more entrenched.

Oral antifungal agents used to treat onychomycosis include; Itraconazole and Terbinafine. Special  consideration must be made before prescribing and taking a course of anti-fungal drugs due to the possibility of systemic side effects, patients must be good health. Liver function tests are required. The drugs can potentially effect the liver, causing hepatic damage.

When taking a drug it is absorbed into skin, nail and hair. Nails do not have direct blood vessels, so the drug is absorbed through the blood stream over time. It cannot be controlled. The drugs will need to be taken for the time it takes for the nail infection to grow out or success rate is reduced. A toenail plate only grows 1mm per month so a long  course of medication is required for a big toenail if it is badly infected.

Antifungal drugs can play a role if there is a recalcitrant Athlete’s Foot skin infection that cannot be controlled with conservative methods.

There are often cases whereby we get patients who have what appears just to be a simple streak of fungal…

Finger nails are subject to much stress whether it be mechanical, in and out of water, then there are ladies amongst…

Clearanail Micro-nail Penetration

Clearanail is a relatively new fungal nail treatment solution. Not to be confused with Curanail topical treatment. Clearanail is based upon Controlled Micro Penetration, using a specialist device to painlessly introduce multiple tiny holes in the nail plate with a precision made tiny drill bit. The holes allow topical treatments to reach the source of infection in the nail bed. Conventional application of topicals are poorly absorbed therefore effectiveness is questionable.

Clearanail is a very effective treatment for recent singular mild to moderate infections. If the nail has a small area of infection then minute holes are introduced around and through it to allow the penetration of Terbinafine Hydrochloride 1%. High concentrations of the drug build up in the nail plate to treat the infection. Results are seen within 2-8 weeks. It is less effective on multiple, older more severe infections.

A photograph will be taken as a record of presenting condition. The nail plate will be debrided or drilled to reduce thickness of nail. Multiple minute holes will be introduced into nail plate and Lamisil Spray, Terbinafine Hydrocholoride 1% will be applied. General advice will be given on home care. A review appointment will be made.

Usually 1 -2 treatments are all that are required depending on severity of infection. It is always important to treat any accompanying Athlete Feet infection and sanitise footwear for infectious spores.

Yes, it is a very safe treatment. The small drill bits are designed to stop when touch soft tissue, using similar technology to the saw used to remove plaster casts. It is safe to use on ‘at risk’ groups, but a thorough consultation is undertaken first to check suitability. Single use specialised sterile drill bits are used during each treatment.

1 Treatment   30 minutes                                                                                                      From:  £80 –  £100

Includes x1 Lamisil Spray

Lunula Laser for Infected Fungal and Non-Infected Damaged Nails

The Erchonia Lunula ‘Cold’ laser light therapy is most advanced, researched and clinically proven treatment for all fungal nail infections. It received FDA market clearance in 2016 to eliminate nail fungus and improve the appearance and health of damaged nails. Compleet Feet have been using the Lunula since 2014 and have successfully treated over 600 cases achieving a ‘clinical cure’ and performed over 10,000 laser treatments. We regularly audit our results. The 2016 audit reveals a 82% success rate. We offer Lunula treatments in all our clinics. The Alton clinic has 2 Lunulas to offer faster treatment times.

The Lunula is a purpose designed laser booth to place either foot or hand in. It safely targets 2 therapeutic low level laser beams over all infected or damaged nails in one session during a 12-minute programme cycle.

  • Antimicrobial 404 nm beam which stimulates the body to produce fungicidal chemicals e.g. hydrogen peroxide
  • Healing 635 nm beam which boosts the immune system to increase blood flow and new nail regrowth
  • Stimulates a body biochemical response akin to a drug interaction to effectively kill dermaphytes from within
  • Speeds up retarded or damaged nail growth
  • Painless and extremely safe

At Compleet Feet we grade the severity of your nail infection to determine how many laser sessions you will require. This will depend on:

  • How many nails are infected and how much of the nail plate is occluded
  • How long the infection has been present
  • Health and age
  • Presence of any skin condition e.g. Athlete’s Foot
  • Infected partners/ family members
  • Occupation
  • Life style

Low grades 4 sessions

Medium grades 6 sessions

High grades 8 sessions

The Lunula is FDA cleared to help improve the appearance and restore the health of damaged nails. Brilliant for fingernail issues. The action of the laser’s wavelengths accelerates nail growth by improving circulation and nutrition to the nail plate. Great for:

  • Nails damaged by UV gels and varnishes
  • Ingrowing nails
  • Damaged and distorted nails
  • Diseased nails
  • Loss of nail plate

This is dependent on what your presenting nail condition is. For fungal nails we initially advise 2 – 3 treatments per week at the beginning of the course going down to 1-2 per week. For damaged nails we recommend 1 session per week to encourage accelerated healthy new nail growth.

We work very hard with our patients to ensure optimal outcomes. A good result is dependent on teamwork. It is very important that patients do ‘their bit’ out of clinic to follow all our advice and instructions. It is important to treat the skin as much as the nails to break the cycle of infection.

Fungal nails:

  • Thorough consultation
  • Grade infection, design a bespoke treatment programme
  • Photograph
  • Debride, reduce damaged nails
  • Start Lunula laser course
  • Advice on home treating, dealing with fungal spores etc.
  • Sanitise footwear (Alton and Brighton have a Klenz nano-silver sanitiser)
  • Issue of anti-fungal products
  • After a completed course a diagnostic culture and photograph will be taken
  • Clearanail procedure may be recommended
  • Offer regular reviews to check progress and encourage healthy new nail growth
  • Offer Wilde-pedique prosthetic  nail plate treatment to improve cosmetic appearance of nail as it grows out
  • Offer NEW Dr. Remedy range of non-toxic  nail varnishes which can be worn safely post laser minimising chances of re-infection

Toenails grow on average 1mm per month. Finger nails 2mm per month. Diseased fungal nails have retarded nail growth. Patience is required for the diseased nail to grow out and new healthy nail to appear. You will initially notice the discolouring e.g. yellow and white patches becoming paler, streaks not increasing in length, nail becoming less spongey, clear pink areas presenting behind diseased area. A diagnostic culture will help to determine whether there is any fungal activity still present or not. We do not like to ‘leave things to chance’ and wait for nail to grow to see results.

 

We cannot guarantee a 100% success for everyone. Nail fungus is a great survivor and opportunist. Every presenting case is different with a different set of variables e.g. lifestyle, health etc. The nature of the infection varies. Our 2016 audit demonstrated a 82% success rate for treating the most difficult of cases.

Generally the Lunula will ‘always’ improve the appearance of nails. If there is still some infection present we will either offer more Lunula at a discounted cost, suggest a Clearanail procedure to get  Terbinafine Hydrochloride 1% into the nail, or suggest removing the infected nail plate and using the Lunula to get deep into the nail bed soft tissues and to encourage new healthy growth.

We do advise the total surgical removal (avulsion) of a diseased nail plate if we feel that the infection is so deeply entrenched and will not, or has not responded to Lunula or other conservative methods as there may be a presenting fungal biofilm (refer to Blog). This is done under local anaesthetic and is a quick painless procedure. There is little to none post-operative discomfort or hindrance on normal activities. The nail bed heals quickly especially with the action of the Lunula laser which promotes healing. The Lunula will also encourage quick new healthy infection free nail growth.

Nail surgery and Lunula – 95% success rate. 1 session required per week

Lunula  – 84 – 87% success rate. 2 sessions required per week

Removing nail plates is quick and easy with quick recovery times. Very little post-operative pain. Nails are designed to fall off and heal quickly after trauma with little impediment on normal activities. We advise restrict high impact activities for 10 – 14 days.

Compleet Feet can surgically remove finger nails unlike other podiatry ciinic. Please ask for Katrina Waller

A full assessment is required first to determine the severity of your infection, then to take into account:

  • Health
  • Age
  • Occupation/lifestyle
  • Sporting activities
  • Other infected partners, loved ones

From a thorough consultation the infection is graded from 1 – 5. A grade 5 is severe

The grading determines how many sessions you will require to treat your infection  between 4 – 8

NEW PRICES FROM MAY 2017

Consultation   £50   30 minutes                 To be included in cost of course if start course on same day

Course prices based on grade of infection and whether 1 or 2 feet infected. Low grade infections require 4 laser session. High grade infections require 6 – 8 laser sessions. Prices start at £50 per session if part of a nail surgery and Lunula laser package.

 

Please note even if the primary infection is present in just 1 foot we always use a Lunula laser on the other to eradicate any spores present that may cause cross-infection. At the Alton clinic we use 2 Lunula lasers at the  same time, still taking only 12 minutes per session.  2 Lunula lasers delivers faster treatment times.

We always work hard to break the cycle of infection by sanitizing footwear. Nails are reduced and made comfortable.

An additional £30 is required if you are to have a culture test to determine if infection is still present after treatment

Partners are discounted at 25% for all courses. It is extremely important to minimise any cross-infection risks

PLEASE NOTE BRIGHTON PRICES MAY DIFFER, AND IF REFERRED BY A THIRD PARTY