Class IV Laser Therapy for Fungal Nail Infection

What is a fungal nail infection?

Fungal nail infection, also known as onychomycosis, occurs when fungi infect the nail.

Affected nails may become:

• yellow, white or brown
• thickened
• brittle or crumbly
• distorted
• separated from the nail bed; or
• uncomfortable in footwear.

Fungal infection can affect one or several nails and can occur alongside fungal infection of the surrounding skin, commonly known as athlete's foot.

Not every thickened or discoloured nail is fungal. Trauma, psoriasis and other nail conditions can sometimes look very similar.

For this reason, your podiatrist will assess your nails and may recommend fungal testing before or as part of your treatment pathway.

What is Class IV laser therapy?

At The Podiatry Clinic, we use a medical Class IV diode laser using 810 nm and 980 nm wavelengths.

Laser energy is applied across the affected nail and surrounding area using controlled treatment parameters.

The aim is to deliver energy through the nail plate and create an environment that may help reduce fungal activity while supporting the overall treatment programme.

The laser does not remove the damaged nail immediately. Improvement depends on controlling the infection and allowing healthier nail to gradually grow forward.

Why do we use a combined treatment approach?

Fungal nail infections can be stubborn and recurrence is common.

Rather than relying on one treatment alone, we aim to address several factors that can contribute to persistent infection.

Depending on your individual nail, your treatment programme may include:

Professional nail debridement

Thickened and damaged nail is reduced to remove affected nail material and decrease the thickness through which treatment needs to penetrate.

Micro-drilling / nail fenestration

Where appropriate, very small channels may be created through the nail plate. This can help topical antifungal treatment reach deeper areas of the affected nail.

Class IV laser therapy

Laser energy is applied to the affected nails as an additional physical treatment.

Topical antifungal treatment

You may be advised to regularly apply an appropriate antifungal treatment between appointments.

Treatment of athlete's foot

Fungal infection of the skin can act as a reservoir for reinfection of the nails and should therefore be treated at the same time where present.

Footwear and hygiene measures

Advice may be given about socks, footwear, nail-care equipment and reducing fungal contamination within your footwear.

Successful treatment depends not only on what we do in the clinic but also on consistently following your treatment and prevention plan at home.

What happens during laser treatment?

Your podiatrist will examine your nails and review your progress.

The affected nails will normally be reduced or debrided where required.

Micro-drilling/fenestration may also be performed where clinically appropriate.

Protective laser eyewear will be provided and must be worn during laser treatment.

The Class IV laser is then applied systematically across the affected nail.

Where appropriate, all toenails may be treated during the appointment, as fungal infection can sometimes be present before obvious changes become visible.

Treatment parameters are selected by your podiatrist according to the nail and your individual treatment plan.

What does laser treatment feel like?

Most patients tolerate the treatment well.

You will usually notice warmth or heat developing within the nail and surrounding area while the laser is being applied.

The temperature is monitored according to your response and the laser is moved appropriately throughout treatment.

Please tell your podiatrist immediately if the area becomes excessively hot or uncomfortable.

Local anaesthetic is not normally required.

How many treatments will I need?

At The Podiatry Clinic, our usual treatment programme consists of approximately:

6 Class IV laser sessions, generally around 2 weeks apart.

Your exact treatment programme may be adjusted according to:

• the number of affected nails
• severity and duration of infection
• nail thickness
• the amount of nail involved
• your response to treatment
• nail growth
• other medical factors; and
• whether additional antifungal treatment is being used.

Laser treatment should be viewed as part of the overall fungal nail management programme rather than an isolated treatment.

How successful is laser treatment?

This is an important question because fungal nail infection can be difficult to eradicate.

Clinical research into laser treatment has reported improvement and fungal clearance in some patients. However, results vary considerably between studies because different laser technologies, wavelengths, treatment schedules and definitions of success have been used.

Research also suggests that laser treatment combined with topical antifungal therapy may produce better outcomes than topical treatment alone.

For this reason, at The Podiatry Clinic we favour a combined treatment programme incorporating appropriate nail preparation, laser therapy, antifungal treatment and reinfection prevention rather than relying solely on the laser.

No treatment for fungal nail infection can guarantee complete clearance, and recurrence is possible even following successful treatment.

When will my nail look better?

Toenails grow very slowly.

Laser treatment does not instantly make an infected or damaged nail look normal.

Even when treatment is successful, the damaged nail must gradually grow forward and be replaced by healthier new nail.

You may begin to notice clearer nail appearing from the base as the nail grows, but significant cosmetic improvement can take several months.

A great toenail can take approximately 12–18 months to completely grow out.

This means that the final result of treatment cannot always be judged immediately after completing the six laser sessions.

What do I need to do at home?

Your home treatment is an important part of the programme.

Depending on your individual treatment plan, you may be advised to:

• apply an appropriate topical antifungal treatment regularly
• treat athlete's foot or fungal skin infection if present
• keep your feet clean and dry
• dry carefully between the toes
• change socks regularly
• rotate and allow footwear to dry
• follow advice about disinfecting or treating footwear
• avoid sharing nail clippers, files or footwear
• keep nail-care equipment clean; and
• continue treatment for the period recommended by your podiatrist.

Stopping home treatment too early can increase the likelihood of persistent or recurrent infection.

What are the potential benefits?

Potential benefits of our combined fungal nail treatment approach include:

• professional reduction of thickened and infected nail
• improved access for topical treatment through fenestration where appropriate
• Class IV laser therapy as an additional physical treatment
• treatment of multiple affected nails
• no local anaesthetic normally required
• little or no downtime for most patients
• treatment of associated athlete's foot where required; and
• a programme addressing both the infection and factors that may contribute to reinfection.

What are the possible side effects and risks of laser treatment?

Class IV laser therapy is generally well tolerated when appropriately performed.

During treatment you may experience warmth or brief discomfort.

Potential side effects include:

• temporary heat or discomfort
• redness
• temporary sensitivity around the nail
• irritation of the surrounding skin
• blistering
• superficial thermal injury or burn; and
• temporary changes in the appearance of the nail or surrounding skin.

Thermal injury is uncommon when treatment is appropriately controlled, but is a recognised potential risk because the treatment intentionally delivers laser energy to the area.

Protective eyewear must be worn because high-powered laser energy can cause serious eye injury if appropriate laser safety procedures are not followed.

If nail fenestration or debridement is performed, there may also occasionally be temporary tenderness, minor bleeding or sensitivity.

Is laser therapy suitable for everyone?

Laser treatment is not appropriate for every patient.

Your podiatrist will consider your:

• medical history
• medications
• circulation
• sensation
• diabetes where relevant
• condition of the surrounding skin
• nail diagnosis
• ability to heal; and
• other factors that may affect treatment.

Please tell your podiatrist if your health or medication changes during your treatment course.

What are the alternatives?

Other treatment options for fungal nail infection may include:

• monitoring without active treatment
• professional nail reduction and regular podiatry care
• topical antifungal medication
• oral antifungal medication prescribed where medically appropriate
• combined topical and oral treatment
• nail fenestration with topical treatment; or
• removal of the affected nail in selected cases.

Oral antifungal medicines such as terbinafine can be effective for fungal nail infection but are not suitable for everyone and may require assessment and monitoring because of potential side effects and interactions with other medication.

Your podiatrist can discuss whether medication or another treatment approach may be more appropriate for you.

How much does treatment cost?

Class IV Laser Therapy for Fungal Nail Infection: £85 per session

Course of 6 laser treatments: £450

Your initial fungal nail assessment and testing, where required, is separate from the laser treatment course.

Your podiatrist will explain any additional products or treatments recommended as part of your individual treatment plan.

When should I contact the clinic?

Please contact us if you experience:

• significant or worsening pain
• blistering or an unexpected skin reaction
• increasing redness or swelling
• discharge or signs of bacterial infection
• unexpected changes in the surrounding skin; or
• anything else that concerns you following treatment.

Please also let us know about any significant changes to your health or medication before your next appointment.

Your next step

If you have already booked your laser treatment

Please attend your appointment as arranged and follow the home treatment advice provided by your podiatrist.

Remember that treating fungal nail infection is a programme rather than a single procedure. Following your recommended antifungal treatment and reinfection-prevention advice between appointments is an important part of your treatment.

If laser therapy has been recommended but you have not yet booked

You can book your Laser Fungal Nail – Follow-Up appointment when you are ready to proceed.

£85 per treatment | Course of 6 treatments £450

Important information

This information sheet is intended to support the discussion you have had with your podiatrist and help you make an informed decision about treatment. It does not replace individual clinical advice.

Fungal nail infection can be persistent, treatment takes time, and recurrence is possible. Complete fungal clearance or restoration of a completely normal-looking nail cannot be guaranteed.

Your podiatrist will monitor your progress and may recommend changing or combining treatments depending on your individual response.

The Podiatry Clinic