Fungal Nail
Treatment

Onychomycosis is a fungal infection of the nail plate and the skin directly beneath it (the nail bed). It is caused by dermatophytes — the same family of fungi responsible for athlete's foot and ringworm — though yeasts and non-dermatophyte molds can also be responsible. It is one of the most common nail disorders seen in podiatric medicine, affecting an estimated 10–14% of the general population and up to 50% of adults over age 70. Left untreated, the infection almost never resolves on its own and can spread from nail to nail, to the surrounding skin, and — in patients with diabetes or poor circulation — pose a serious risk for secondary bacterial infection, cellulitis, and even ulceration. Early treatment is always preferable to waiting for the infection to worsen.

Oral antifungal medications such as terbinafine (Lamisil) and itraconazole (Sporanox) require 6–12 weeks of daily dosing and carry real risks: liver toxicity, drug interactions, and gastrointestinal side effects. Patients on certain cardiac medications or with pre-existing liver disease may not be candidates at all. The Lunula laser, by contrast, delivers its dual-wavelength light energy directly through the nail plate to the fungal colony without systemic exposure. There is no liver risk, no drug interaction concern, and no need for blood monitoring. Clinical studies show mycological cure rates comparable to oral therapy — with a safety profile that makes it appropriate even for patients with diabetes, kidney disease, or polypharmacy. For patients who simply prefer to avoid daily medication, the laser is a compelling alternative.

The standard protocol is four sessions spaced one to two weeks apart. Each session is 12 minutes per foot (or per affected toe cluster, depending on the spread). Dr. Katz will assess your nails after the initial course and may recommend a maintenance session or two if the infection was extensive or if multiple nails were severely involved. Patience is essential: because nails grow slowly — roughly 1.5 mm per month for toenails — it takes 9–12 months for the great toenail to fully grow out. You will begin to see a clear, healthy nail root emerging from the cuticle within 3–6 months, and that new growth is what indicates the infection has been cleared. The existing discolored nail plate grows out and is trimmed away over time.

The Lunula laser is classified as a low-level (cold) laser, which means it does not generate heat intense enough to cause pain, burning, or tissue damage. Most patients describe feeling a mild warmth or a faint tingling under the nail during treatment — some patients feel nothing at all. There are no needles, no incisions, and no anesthesia required. This makes it an excellent option for patients who have anxiety about medical procedures or who have peripheral neuropathy and impaired sensation. You can drive yourself to and from each appointment and return to work, the gym, or daily activities immediately afterward.

Recurrence is the most frustrating aspect of onychomycosis management. Even after successful treatment — whether topical, oral, or laser — the fungus can be reintroduced from environmental sources: contaminated shoes and socks, public locker rooms, shared nail tools, or reinfection from untreated athlete's foot on the same foot. At Katz Regenerative Foot & Ankle, we address this comprehensively: we treat all affected nails (not just the most visible ones), recommend antifungal shoe spray for your footwear, counsel on proper moisture management, and — where athlete's foot is co-present — treat that simultaneously. We also discuss lifestyle adjustments such as changing shower socks, replacing old footwear, and drying between the toes carefully after bathing. Without addressing the environmental reservoir, even the best laser treatment can be undermined.

There is no case that is too mild to treat. Even early-stage onychomycosis — a small white or yellow spot at the nail tip — will not resolve without intervention, and the longer it goes untreated, the deeper the fungus penetrates beneath the nail plate, making treatment progressively more difficult. Conversely, no case is too severe to benefit from laser therapy: advanced infections with significant nail thickening, crumbling, and subungual debris are common presentations in our clinic, and while they require diligent follow-up and sometimes nail debridement before laser sessions, they respond well to the Lunula protocol. If you have diabetes or compromised circulation, please do not delay — fungal nail infections can create a portal of entry for bacterial infection that escalates quickly. Dr. Katz will assess severity at your first visit and outline a realistic timeline for your specific case.