Gilchrist Dermatology is proud to offer PinPointe™, the only FDA-cleared laser for nail fungus removal, to Encinitas and the surrounding North San Diego County communities of Oceanside, Carlsbad, Cardiff, Solana Beach, Del Mar, and La Jolla.
Q&A with Dr.Gilchrist about nail fungus treatment with a laser:
How does it work?
First, I may trim the nails and use a machine called a PodiaPro to painlessly sand down any thick areas in the nail. This ensures that the laser can penetrate through all areas of the nail. Next, I use the PinPointe™ laser to stack a series of tiny pulses of energy into the nail, generating enough heat to kill the fungus. The nail with the dead fungus then grows out slowly over 6-12 months, allowing a new nail to grow in without becoming continually infected by the old nail as it grows.
Does it hurt?
Most people feel nothing at all or a warm sensation. However, to be honest, I have had some patients experience a burning pain during the treatment. Usually, these people have fibromyalgia, neuropathy, or some other condition that lowers their threshold to pain. In such a case, I simply slow the speed of the laser, and the patient is generally able to tolerate the treatment quite easily.
How long does it take?
Laser treatment of a nail takes 5-10 minutes, depending on the size and thickness of the nail. The entire length of your appointment will depend on how many nails you have treated. I also allow plenty of time for explaining the procedure and explaining how to take care of your nails after the treatment in order to avoid reinfection.
Can you treat fingernails as well as toenails?
Yes, indeed. I just have to run the laser more slowly because fingernails are more sensitive than toenails.
How much does it cost?
Your investment starts at $50 for one nail, one treatment. It is strongly recommended that you repeat the treatment at monthly intervals to ensure the greatest possible chance of clearing the fungus.
Why should I have all my toenails treated if only 1-2 are infected with fungus?
Because all those toes live in the same shoe. Sometimes nails can have a minimal or early infection, despite looking mostly normal. Because the goal is to avoid reinfection, it makes more sense to sterilize all the nails at once.
How much is a consultation visit?
A consultation is usually covered by health insurance. If you choose not to use insurance, the fee is $150.
Why should I have a consultation?
Because all that distorts or discolors nails is not fungus. Other things can cause odd-looking nails, such as psoriasis, lichen planus, yeast infections, bacterial infections, and just plain rubbing against your shoes. Before you spend your hard-earned money on laser treatment, it’s a good idea to first make sure what you are treating. Your consultation fee essentially buys you a medical office visit for diagnosis of your nail problem. If the laser treatment isn’t for you, I’ll tell you, and we can discuss your other options, such as prescription medication, injections, or nail surgery.
Why don’t you guarantee a cure?
Because nail fungus is not death or taxes. I know that some practitioners “guarantee” a “cure” of your nail fungus. However, medicine has no 100% guarantees. Complete clearance of the nail depends on completing the laser treatments as recommended, on your careful adherence to measures to prevent reinfection, and on how well your individual immune system fights off reinfection. However, just one laser treatment usually results in about a 70% cure, and I highly recommend that you have monthly follow-up treatments until the nail has grown out to ensure your best chance of success.
What can I do to avoid reinfection?
- Consider having all 10 nails treated with the laser if the infection is in your toenails.
- Apply a topical antifungal prescription medicine to your nails and around your nails Every. Night. For. The. Rest. Of. Your. Life. I sell FungiFoam® at a reasonable price as a convenience for my patients, but I’m happy to give you a prescription to take to the pharmacy of your choice if you don’t want to buy the FungiFoam.
- Get the fungus out of your shoes by some combination of the following: You can discard them all and start over. You can use an antiseptic spray to coat the insides. I like Clean Sweep™, and I carry it in the office. You can buy UV emitting shoe inserts to sterilize the insides of your shoes. I don’t stock these, but you can order them online through retailers such as amazon.com.
- Wear sandals or thongs in wet public areas (locker rooms, showers, pools, spas, etc.).
- Keep your feet and nails clean and DRY. Wear open-toed shoes whenever possible. Always wear socks with close-toed shoes. Change your socks as often as necessary if your feet sweat a lot. When you arrive home or at night time, use foam pedicure toe separators to encourage air circulation if your toes naturally tend to crowd together.
What are my other options for treating nail fungus?
- You can do nothing. The fungus is unsightly and it tends to get worse over the years, but it’s not dangerous, and doing nothing is a valid option.
- You can take prescription antifungal medicine (Lamisil®, Sporanox®, or Diflucan®) by mouth for 3 months. These medications deposit in the root of the nail. They don’t kill the existing fungus because they can’t penetrate (like a laser) into the nail that’s already there, but by depositing in the nail root (nail matrix) they do give about a 70% chance of growing out a new clean nail over 6-12 months. You do have to have blood tests to monitor your liver while taking these medications because they can cause inflammation of the liver.
- You can have the infected nail surgically removed and then use topical antifungal medications while it regrows. Surgical removal, however, carries a small chance of the nail growing back abnormally (grooved) or not at all.
Is laser treatment covered by health insurance?
Unfortunately, no. Laser treatment of nail fungus is considered cosmetic by most health insurance companies. However, if you have health insurance, it may cover your initial consultation visit, at which we diagnose your nail problem and discuss the treatment options. My office accepts Medicare, Tricare, and all major PPOs.
Call me at 760.230.2537.