NAIL FUNGUS AND LASER
Nail fungus; is a fungal infection of the hand or toenails. Thickening of hands or toenails causes discoloration and discoloration. Several types of fungi can be caused by nail fungus. Fungus develops in a damp and airless environment inside the shoes. Toenail fungus can prepare the appropriate environment for nail fungus.
What are the symptoms of nail fungus?
Nail color turns yellow or brown. The nail thickens and grows excessively. There may be a smelly buildup under the nails. As the infection progresses, the nail may become crumbly and spilled, or it may become thick enough to cause discomfort or pain in the shoe.
How is nail fungus diagnosed?
Your dermatologist can diagnose by looking at the appearance of your fingernails and hands. Sometimes small samples can be taken from your nails. These samples are sent to the laboratory for testing and the diagnosis is definitive.
What are the factors that can increase your risk of nail fungus?
• Professions whose feet remain moist for a long time (soldiers, athletes, miners, etc.)
• A history of illness (diabetes, circulatory disorder, HIV) that may reduce your resistance to infection or prevent blood flow to your toes.
• Nail injury, trauma
• Wearing narrow and pointed shoes that pinch the fingers,
• Use of common areas such as changing rooms, swimming pool and shower
• Wearing the same shoes in a row
• Manicure and pedicure in non-hygienic environment with non-sterilized instruments
• Pressing the soil with bare feet
• Humid environment caused by excessive sweating of feet
• Poor foot hygiene
What is the expected duration of nail fungal disease?
Nail cork rarely heals itself. It is usually a chronic (long-lasting) condition. It may worsen and affect other nails. Although the affected nail falls, the new nail may be infected with fungus.
How is nail fungus protected?
To protect from nail fungus:
• Wear comfortable shoes and socks that allow your feet to breathe.
• No shoes, sandals or slippers belonging to others should be worn in common shower and dressing rooms.
• Wash your feet every day. Dry thoroughly and use a quality foot powder.
• Wear clean socks every day.
• Keep your nails short.
• Disinfect pedicure instruments before use.
How to treat nail fungus?
Treatment may begin with the removal of the infected nail as far as possible by your physician. This can be done as follows:
• Cutting the nail with scissors
• Rasping
• Melt with a cream containing urea
If your infection is mild and limited to a small area of your nails, your dermatologist may give you an antifungal cream or medicated nail polish. If the infection is on a large area of your nail or a few nails, your doctor may give you oral antifungal therapy such as terbinafine or itraconazole. Both drugs can sometimes cause distressing side effects. Itraconazole may cause serious drug interactions. If the nail fungus is resistant to treatment in very severe cases, it may be necessary to remove the entire nail surgically.
How does the nail look after treatment?
Many individuals can be treated with oral antifungal drugs for several months. However, even after the fungus has died, the nail may not return to its normal appearance. Some individuals may relapse even after successful treatment with oral antifungal medication.
LASER TREATMENT IN NAIL FUNGUS
Nail fungal disease - onychomycosis constitutes 3 Te 1 of skin fungal diseases and 50% of nail diseases. It is frequently observed in adults. It affects the nail plate (the nail itself), the nail bed and the nail matrix (root), the nail-making center. Fungal diseases of nail are a serious health problem because of the development of pain, causing other infections and being contagious. Particular attention should be paid to elderly patients, diabetics and patients with defensive problems. It also causes serious aesthetic problems in hands and toenails.
Treatments in nail fungal diseases can be grouped into 4 groups.
Removal of fungal nail areas from the nails by mechanical methods and / or medications. As these treatments are long lasting and laborious, patient compliance is not very good. The success of the treatment is low and the recurrence rate of the disease is high.
Apply fungicides to the nails for 3-6 months; The absorption of drugs from hard tissue such as nails is quite low. Treatment duration and daily use reduce patient compliance. In addition, the success of the treatment is low and the recurrence rate of the disease is high.
The use of oral fungicides for 3-6 months; Daily or weekly medications are used throughout the treatment. Its use is limited due to incompatibilities of its side effects and concomitant use with other drugs.
Laser and light treatments; systemic and local treatment resistant nail fungal diseases or patients who can not receive systemic treatment (elderly, children, liver problems, etc.) is preferred. Such as CO2 lasers, Nd: YAG lasers, 870/930-nm IPL systems, UV and photodynamic treatments.
Nail is a slowly growing skin patch. Treatment of nail fungus provides new healthy nail development. Therefore, regardless of the treatment, the clinical improvement of the nail varies depending on the involvement of the nail, but lasts for 3-12 months.
Laser treatments; With its low risk and wide safe usage, high patient compliance and clinical improvement, it is among the first treatment options in nail fungi.
The first laser system used in nail fungi is the long-shot Nd: YAG laser. When laser radiation is applied to the nail, it is absorbed by the tissues in the nail and nail bed and heat is generated. In clinical studies, it has been shown that nail laser increases the temperature to 48-51 C after application and this heat destroys fungal agents and bacteria. The laser does this without damaging the nail bed, the nail and the surrounding soft tissue.
Laser is applied on the nail with fungal infection covering the entire area of the nail. This application is repeated 1-3 times with 2-3 minutes intervals in the same session according to the nail fungus clinic. The following figure shows the application of the laser, the 48-51 C temperature rise in the nail with the thermal imager during the application.
Treatment of nail fungus 2
This heat that occurs during the application causes warming and tingling sensation in many patients during the session. During the application, there is a slight pain that the patient can tolerate easily. Cooling systems are often not preferred when it is considered that our aim is to heat the nail in the laser structure with the support of cold air without the need for local anesthesia. However, it can be used in people who cannot tolerate heat. There is no need for painkillers, dressings and medication. There is no need for rest since there is no limitation of pain and daily activity on the days after the session. There is no restriction for nail manicure, pedicure and nail polish use after laser treatment.
There is no change in the nail fungus clinic during and immediately after treatment. Elimination of fungal agents in the nail after laser healthy nail elongation occurs over time. After laser treatment, there is clinical change in hand nails 2-6 months and toenails 3-12 months.
The sessions are 2-4 sessions with 1 week intervals for a nail.
Laser application time varies between 15-45 minutes depending on the number of nails to be treated.
The superior side of laser treatment in nail fungus treatments is that it is effective against both fungal agents and bacteria. Because in nail fungal diseases, some bacteria can multiply in the nails.
Another used laser system in nail fungal diseases is Q switched lasers. When fungi and bacteria settle in the nail, some of the pigment substances they secrete can give the nail a green, black or even yellow color. Q switched lasers can also be used by targeting these pigment materials.
If the patient does not take protective measures after the fungus, the disease may recur in the same nail or others.
Fractional Co2 lasers have recently been used in the treatment of nail fungi. Clinically, fungal areas of fungal nails are treated with 3 sessions of fractional Co2 laser at 4 weeks intervals. Since this application is painful, local anesthesia is needed beforehand.
Between the sessions, the patient should use creams or nail solutions on these nails. The aim of this application is to open micro tunnels on the nail with Co2 laser and increase the absorption of drugs from the tunnels.
Laser treatment of nail fungus; should not be done in patients who have used isotretionin in the last 6 months, in those who use vasodilator drugs, who use permanent or semi-permanent paint on the fingernail (even if the nail polish is removed).
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