Abstract - edited text, Heyes RR (2015):
Fungal nails are often left neglected and at best conservatively managed, and therefore it is not surprising that the most common foot complaints are nail related - such as fungal nails, followed by corns and calluses (1). Chronic fungal nail infections affect approximately 10% of the population (2,3). Fungal nails (onychomycosis) increases significantly in adults over the age of 60 years with up to 28% incidence (4), and dystrophic nails may pose an increased risk of developing pressure sores, with resultant ulcers and secondary bacterial infection. It had been reported in one study of 150 subjects with fungal toenails, that 54% had toenail discomfort, whilst 36% reported pain on walking limiting actual mobility (5). Often patients are unable to successful manage or cut a thickened dystrophic fungal nail, leading to embarrassment and psychosocial problems. A safe and effective treatment for fungal nails is needed, especially with patients who would be unable to tolerate or risk the side effects attendant with systemic oral anti-fungal treatments i.e. the immunocompromised / or elderly patients with contraindications / or young children.
Topical antifungals seem to be unable to penetrate the thickened nail plate, and a total nail avulsion to allow access to the nail bed for fungal treatment - is often deemed as too destructive (with its own added complication such as risk of subsequent infection) given that it could take in excess of 12 months for the nail to fully regrow.
There are commercially available photodynamic therapy (PDT) units such as the “PACT Med” laser (Hahn Medical Systems, LED light at wavelength 630 nm) which is used in conjunction with a photosensitising gel (toluidine blue based) to generate "activated oxygen" or reactive oxygen species, which kills bacteria / fungi and viruses by destroying their cell walls (7), without adversely affecting the surrounding tissue. Previous in-vitro studies have shown that mammalian cells subjected to the same PDT conditions, displayed no signs of toxicity or mutagenic effects (8). Recent studies have shown great success with PDT in treating chronic fungal nails (9), and that PDT has the potential to provide an effective antifungal therapy without all the prolonged and serious side effects that can accompany traditional oral antifungal medications (10).
References:
Fungal nails are often left neglected and at best conservatively managed, and therefore it is not surprising that the most common foot complaints are nail related - such as fungal nails, followed by corns and calluses (1). Chronic fungal nail infections affect approximately 10% of the population (2,3). Fungal nails (onychomycosis) increases significantly in adults over the age of 60 years with up to 28% incidence (4), and dystrophic nails may pose an increased risk of developing pressure sores, with resultant ulcers and secondary bacterial infection. It had been reported in one study of 150 subjects with fungal toenails, that 54% had toenail discomfort, whilst 36% reported pain on walking limiting actual mobility (5). Often patients are unable to successful manage or cut a thickened dystrophic fungal nail, leading to embarrassment and psychosocial problems. A safe and effective treatment for fungal nails is needed, especially with patients who would be unable to tolerate or risk the side effects attendant with systemic oral anti-fungal treatments i.e. the immunocompromised / or elderly patients with contraindications / or young children.
Topical antifungals seem to be unable to penetrate the thickened nail plate, and a total nail avulsion to allow access to the nail bed for fungal treatment - is often deemed as too destructive (with its own added complication such as risk of subsequent infection) given that it could take in excess of 12 months for the nail to fully regrow.
There are commercially available photodynamic therapy (PDT) units such as the “PACT Med” laser (Hahn Medical Systems, LED light at wavelength 630 nm) which is used in conjunction with a photosensitising gel (toluidine blue based) to generate "activated oxygen" or reactive oxygen species, which kills bacteria / fungi and viruses by destroying their cell walls (7), without adversely affecting the surrounding tissue. Previous in-vitro studies have shown that mammalian cells subjected to the same PDT conditions, displayed no signs of toxicity or mutagenic effects (8). Recent studies have shown great success with PDT in treating chronic fungal nails (9), and that PDT has the potential to provide an effective antifungal therapy without all the prolonged and serious side effects that can accompany traditional oral antifungal medications (10).
References:
- Mason N. Podiatrists: We Want National Awareness Campaign. www.exceed-magazine.com: February 2016: page 5. http://exceed-magazine.com/news/podiatrists-demand-national-awareness-campaign/
- Roberts DT. Prevalence of dermatophyte onychomycosis in the United Kingdom: results of an omnibus survey. Br. J Dermatol 1992: 126: 23
- Gupta AK, Jain HC, Lynde CW, Macdonald P, Cooper EA, Summerbell RC . Prevalence and epidemiology of onychomycosis in patients visiting physicians’ offices: a multicentre Canadian survey of 15,000 patients. J Am Acad Dermatol 2000: 43: 244-248
- Gupta AK, Jain HC, Lynde CW. Prevalence and epidemiology of unsuspected onychomycosis in patients visiting dermatologists’ offices in Ontario, Canada – a multicentre survey of 2001 patients. Int J Dermatol 1997: 36: 783-787
- Schein JR, Gause D, Stier DM, et al. Onychomycosis: baseline results of an observational study. J Am Podiatr Med Assoc 1997: 87: 512-519
- Heyes, RR. Photodynamic therapy in the treatment of onychomycosis. Unpublished manuscript, Salford University (2015)
- Donnelly RF, McCarron PA, Tunney, MM. Antifungal photodynamic therapy. Microbiological Research 163 (2008) 1-12
- Zeina B, Greenman J, Corry D, Purcell W M. Antimicrobial photodynamic therapy: assessment of genotoxic effects on keratinocytes in vitro. Br. J Dermatol 2003;148:229-32
- Figueiredo Souza LW, Souza SV, Botelho AC. Randomized controlled trial comparing photodynamic therapy based on methylene blue dye and fluconazole for toenail onychomycosis. Dermatol Ther. 2014 Jan-Feb;27(1);43-7
- Hay RJ. New developments in antifungals. Int J Dermatol S 1999:2:65-9
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