What can we do for you? 

There is no accepted medical classification system for the severity of nail fungus beyond mild, moderate and severe. The Journal of the American Medical Association’s Dermatology edition published an article in 2011 that lists a classification system based on a point scale from 1-35, with 1-5 considered mild, 6-15 considered moderate, and 16-35 severe. To determine severity, health professionals use the percent of the nail surface involved, the proximity of the infection to the nail matrix (cuticle area), along with other associated signs and symptoms like thickening of the nail, discoloration, brittleness, and distortions in shape and nail growth patterns. Flaky skin surrounding the nail, or a rash along the bottom of your foot, indicates a concurrent fungal infection of the skin.

With more mild infections the patient may not realize they have nail fungus. By the time the infection becomes apparent it has likely already progressed to a more serious condition requiring more focused treatment than the common at-home remedies, and over-the-counter medications, can provide. This is the reason why it is estimated that as many as 10% or more of healthy adults suffer from toenail fungus. For people over the age of 60 the prevalence jumps to over 50%.

• It’s impossible to drastically change the way the nails appear immediately, aside from thinning and reshaping them.
• The goal of treatment is to help the new nail growth to come in healthy, thin, and clear of any discoloration.
• Full resolution is generally achieved through a 12-month regimen including the application of topical medications along with laser treatment.
• The number of laser treatments will depend on the severity of your particular infection.

Treatment

Here at the Golden Gate Foot and Ankle we provide a treatment protocol specific to each patient and the degree of infection present. Often, topical medications along with laser treatment are enough to cure all but the more stubborn infections. The topical medications we prescribe are the latest, most effective options available, and we have pharmacies that work with us to offer them at an affordable price.

Topical Medications:

• Jublia (efinaconazole)
• Kerydin (tavaborole)
• Formula 7 (tolnaftate)

Mild

Mild infections can often be resolved with topical medications alone, but by adding one to three laser treatment sessions over the recommended 12-month period of topical medication use we can help ensure you achieve the results you desire.

Moderate

Moderate infections are rarely resolved with the use of topical medications alone. The addition of monthly laser sessions will greatly increase the odds of successful treatment. The number of laser sessions required will vary for each person depending on the severity of infection, their age, overall health, and how quickly their nails respond to treatment.

Our laser is painless, and any warmth or slight discomfort you may feel is over the moment we’re done. As part of the laser treatment process, your nails will also be smoothed down to a more normal appearance, providing not only an immediate cosmetic improvement, but also more effective results from the topical medication by allowing the medication to penetrate down deeper into the nails, where it’s needed most.

Severe

In severe cases, where the infection has gone untreated for years, Dr. Dupont may suggest a more proactive approach, which can include the complete, but temporary, removal of the most severely infected nails. By removing the nail we are able to remove the majority of the infection, thereby making complete eradication substantially easier to achieve. Temporarily removing the nail is usually not enough on its own to cure the infection. However, when combined with the application of the newest, most effective topical medications while the new nail regrows, you will be left with feet that you no longer want to hide. Nail removal is also the fastest way to a cosmetic improvement, with the nail beginning to appear normal in as little as two to three months.

Having a severely infected nail removed may sound like a painful process, but with eighteen years of experience and thousands of nail procedures performed, Dr. Dupont will make it a fast and nearly painless process.

The use of oral antifungal medications, like Lamisil (terbinafine), are generally avoided when possible. This is reserved only for the most severe fungal infections due to the potential side effects of the oral medications, including liver damage. Topical medications and laser treatment are a much safer option and do not require the liver function testing commonly recommended with the use of oral antifungal medications.

Please click to read John's Journey

“5 months after removal of the large toenail it’s growing back completely free of fungus”

Laser Treatment

Laser devices emit light that transfers heat energy to the tissues and fungal cells it contacts.  The exact mechanism is still unknown, but it’s theorized that this heat energy produces an antifungal effect when absorbed by the fungal cells.

The light emitted by the laser is able to penetrate the entire toenail, reaching all portions of the thickened nail, including down to the nail bed.  This allows the laser to penetrate down to where topical or even oral medications struggle to reach.

Each specific type of laser differs slightly in the wavelength used, but they all rely on heat energy being transferred to the fungal cells, thereby helping to destroy those cells and eliminate the underlying infection.  For a strong antifungal effect to be produced, a slight warmth is likely to be felt.  This has no negative effect on the surrounding nail tissue.

When laser therapy is combined with the latest topical medications, this provides the best treatment option for toenail fungus, without the potential side effects of oral antifungal medications.