Achieving Maximum Onychomycosis Clearance Rates
As well as our own multi-centre Clinical Study, Ellipse has undertaken a literature review, taken expert opinion from the dermatologists we work with, and picked up information from conferences around the world. Based on this, we are pleased to offer this short professional guide to treatments, and how to get the best possible clearance result. A patient guide is also available.
Background – When we introduced the treatment , we were quite clear that the treatment is ”Temporary increase of clear nail in patients with onychomycosis”. This is also the approved wording of the US Food and Drug Administration (FDA). In other words, this is not a vaccine guaranteeing permanent freedom from nail fungus. An individual patient may have nail fungus because of injury to the nail or because of health or environmental factors – all of which make reinfection possible. This is equally true if the treatment is based on medication or on light, and in both cases health and lifestyle changes can help to reduce the risk of reinfection. A list of recommendations to patients is shown in the patient guide.
The sub-millisecond pulse is better. Our original study compared a 35ms pulse with a sub-millisecond one, and the 12 month follow-up clearly shows the superiority of the shorter pulse.
Ellipse has had no negative feedback about the efficacy of our treatment, but various national conferences have included comments that with other light-based treatments, reinfection occurs before the whole nail is clear. We would therefore make the following suggestions to maximize the treatment effect:
- If nails are thick, file them down to 1-1.5mm thickness before laser treatment is performed.
- Perform 4-5 treatments with 1-3 weeks interval to maximize the destruction of the fungus.
- Use 4 consecutive passes on each nail, before changing to the next nail. Treat a fifth pass as optional.
- Use a fluence of at least 16J/cm2. Higher fluence will improve the result, so increase up to 22 J/cm2, if the patient can tolerate it.
- Undertake a 3 month post treatment follow up. If in doubt that all fungus has disappeared, perform an additional treatment.
- Ask the patient to come for a check-up every 6 months until all nails have completely recovered and perform an additional treatment until complete clearance is achieved.
- Laser treatment might benefit from the combination of home treatment with a water based topical nail lacquer such as Onytec or Ciclopoli, with 8% ciclopirox(i) (ii) , as the active compound, applied to the nail in accordance with manufacturer’s instructions.
- Ensure that the patient is fully aware of his or her role in preventing reoccurrence.
- If there appears to be no improvement after treatment, check that the patient does have onychomycosis and not another disease such as psoriasis.
(i) Monti D, Tampucci S, Chetoni P, Burgalassi S, Mailland F. Ciclopirox vs amorolfine: in vitro penetration into and permeation through human healthy nails of commercial nail lacquers. J Drugs Dermatol. 2014 Feb;13(2):143-7
(ii) Togni G, Mailland F. Antifungal activity, experimental infections and nail permeation of an innovative ciclopirox nail lacquer based on a water-soluble biopolymer. J Drugs Dermatol. 2010 May;9(5):525-30.
If you want to download the Whitepaper click here.
If you want to download the Patient Guide click here.