Laser treatment of fungal nails. You have seen the ads. Now let me fill in the back story and give you some honest information.

The story starts with the father of a child with cystic fibrosis.

An engineer by profession, he began researching the ability to create a laser light that could penetrate delicate lung tissue and kill bacteria without hurting the lungs. Along the way to his Holy Grail of CF care, he tuned the laser light to a different wavelength and found that he could kill fungus in nails without harming the nails or surrounding skin. Fungal nails is a huge market, and any profits he could generate he could use to fund his CF research.

Almost two yeas ago the trials started on patients in two podiatry offices in Sacramento and one in San Jose. The results were better than they imagined.

They reported that almost 90 percent of the patients they treated with the laser showed improvement in the appearance of the nails as the nails grew out.

These patients provided the information needed for the FDA’s approval to treat nail fungus with the laser.

Some of these patients had tried to kill their nail fungus for years with topical medicines but failed and were afraid to use the oral medication Lamisil for fear of liver damage.

The laser seemed like a winner, and the company that produced the laser, Patholase Inc., began marketing the PinPointe laser systems. So far about 45 podiatrists across the nation have the PinPointe laser. You may have seen it featured on a “Good Morning America” segment.

Treatment with the laser is rather simple. The first step is to trim the nails down to the thickness of normal nails.

The importance of this step cannot be overestimated. This mechanical treatment is almost never done by dermatologists, and it is illegal for a pedicurist to do it.

It is, however, very familiar to podiatrists, which is why the laser has mainly been marketed to us. We have a whole series of burs and sanders that thin the nail without causing pain or bleeding. The laser will not work on a thick nail that has not been properly thinned.

After thinning the nails and donning special laser goggles, we apply the laser light to every portion of the infected nail in a process that takes 40 minutes.

There is no real pain with the lasering, just an occasional fleeting pinprick-like feeling.

After treatment, all activities can resume immediately with no posttreatment pain or disability of any kind.

The “Good Morning America” segment indicated that the average cost of treatment in New York is about $1,200. We charge less than that.

The alternative to laser treatment is either the daily use of a topical medicine (there are dozens of types) that never really kills the fungus or the use of oral Lamisil pills.

I think Lamisil is an effective drug and use it frequently, but there is always the concern of possible damage to the liver, kidney and bone marrow.

Lab tests are always required to make sure Lamisil is not causing any harm. No testing of any kind is required for laser therapy, and there are no real obstacles to treatment, although we avoid pregnant women and patients with cancer whenever we can.

After treatment with either the laser or Lamisil, precautions need to be taken so that contact with new fungus spores does not lead to a new infection.

Daily use of an anti-fungal cream is the mainstay of treatment. Shoes should be sterilized by either spraying them with an anti-fungal spray or using an ultraviolet light shoe tree. Plastic sandals and shoes should be sprayed with Lysol, as should the bath and shower area.

Our office has used the pinpoint laser for about nine months. At the four-month follow-up 50 percent of our patients are having remarkably successful results, and it is too early to tell with the other half because not enough nail has grown out.

Certainly some of our fourmonth failures will be eightmonth successes. But even if it is only 50 percent successful, none of these patients were helped with topical medication and the laser treatment has virtually no risks at all.

For more information, visit www.LaserMyToes.com.

Dr. Michael Zapf is a board certified podiatrist with offices in Agoura Hills and Thousand Oaks. For more information, call (818) 707-3668 or visit www.conejofeet.com.