Ask Well: Laser Treatments for Nail Fungus

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Laser treatments for nail fungus have become fairly common since the procedure was approved by the Food and Drug Administration four years ago. Several kinds of laser therapies are now available, but there is limited evidence that the treatments work.

The appeal of lasers is that they selectively heat and destroy harmful fungi while sparing healthy surrounding tissue. And some small studies and lab tests suggest they can kill the fungi and cure the condition.

But in one of the best studies to date, published last year in The Journal of the American Academy of Dermatology, researchers at the University of Alabama at Birmingham found that laser treatments produced no improvements in patients with toenail fungus, even after five sessions.

The procedures are generally not covered by insurance, and a course of treatment typically involves multiple sessions, each costing hundreds of dollars, said Dr. Andrea Bershow, the director of the nail procedure clinic at the Minneapolis VA Health Care System.

“I think we want it to work, but the evidence just isn’t quite there yet,” said Dr. Bershow, who published a report last year that reviewed current research. “The studies that have shown efficacy have been small, they haven’t been randomized controlled trials, and most of them have been funded by the actual laser companies themselves.”

Dr. Bershow says she frequently treats patients with the oral drug Lamisil because it is cheap, it works and it is generally very safe. But many people are reluctant to take it because in very rare cases it may cause liver damage. When all else fails, some patients elect to have their toenail removed and the nail matrix medically destroyed to prevent the nail from growing back.

Dr. Bershow is frequently asked about laser treatments, but she never recommends them.

“The reason is that I don’t know if it works, but it does cost a lot of money,” she said. “I would hate to tell someone to go try something that insurance doesn’t cover, that could cost them thousands of dollars, and that may or may not work.”