Toes on the Go
Michele Kraft, DPM
Podiatrist located in Carmel, CA
About Erchonia Erchonia is the global leader in low level laser healthcare applications. For nearly 2 decades, Erchonia has been conducting research and development with the world’s leading physicians to advance the science of low level lasers. Erchonia created the low level laser category after the company was granted the first low level laser FDA clearance for any indication in 2002. Prior to market introduction, all Erchonia lasers are proven safe and effective through independent clinical trials. Currently thousands of Erchonia’s lasers are used daily to reduce body fat, eliminate pain, accelerate healing, treat acne, treat the appearance of cellulite, treat onychomycosis and veterinary applications. For additional information, visit www.erchonia.com.
Luna Laser Q & A
Is the laser FDA approved?
Yes. Erchonia submitted the results of their successful clinical trial and the laser was granted market clearance by the FDA in June 2016 for the treatment of onychomycosis.
What are the advantages of the Erchonia Lunula onychomycosis laser device?
This device is unique in that it is the only true, dual diode, non-thermal, unattended Class 2 laser that offers multiple benefits. The Lunula combines the anti-fungal effects of the 405 nm wavelength with the regenerative outcomes of a 635 nm wavelength. The Lunula produces two wavelengths, 635 nm and 405 nm, both of which have been enriched by a proprietary rotating line-generated laser beam. The Lunula’s specially designed delivery mechanism maximizes both photon concentration and treatment surface area. The Lunula’s patented delivery system ensures that all infected tissue, nail bed and most importantly, the proximal germinal/matrix tissue are properly targeted and treated.
Are all laser wavelengths the same?
No. The higher wavelengths have less energy and normally more power is added which produces heat. Normally output power of watts and wavelengths of 900nm or higher are considered Class IV devices and produce an increase in temperature in the tissue being treated. The lower wavelength lasers, Class 2, Class 3A and 3B depending on power output, do not rely on heat production. Cold lasers initiate true physiologic responses, photo modulation. The Class2/3A/3B lasers have wavelengths 700 nm or lower.
Can I feel the laser working?
The patient will feel no heat or any sensation from the laser.
Is the tissue response the same with the lower wavelengths in the Lunula?
No, the lower the wavelength, the greater energy produces and the greater antimicrobial/antifungal effect, high powered lasers work by boosting power to overcome the antimicrobial/antifungal but this can cause tissue destruction which is evidenced by the heat and smoke dangerous smoke plumes they produce.
What is the advantage utilizing a multiple diode approach in the treatment of onychomycosis?
The 635 nm wavelength stimulates endogenous mechanisms, which enhances the immunological function of resident neutrophil and macrophage function to further degrade the infectious agent. This wavelength also induces tissue rejuvenation, increased vascularization, which enables the dual diode approach to accelerate the growth of new clear nail growth. The 405 nm wavelength provides anti-microbial, antibacterial and anti-fungal effects. The patented dual diode approach provided by the Lunula Onychomycosis Device provides symbiotic wavelengths that enhance new clear nail growth at 6 months.
What kind of response have been seen when utilizing the dual diode lower wavelength approach in the treatment of onychomycosis?
In the clinical trial results 89% of patients respond.
Are there any complications with LunulaLaser therapy?
No complications were reported in all 4 LunulaLaser clinical trials.
Is it recommended to obtain fungal cultures prior to low-level laser therapy?
During the Lunula clinical trial, a positive mycology study was received on all patients.
What are the risks with using a heat-based Class IV laser as opposed to a true cold laser?
When using heat-based lasers to treat nail fungus, there are risks: thermal burning, necrosis, pain, threat of airborne mycosis with the potential of pulmonary ingestion with resultant longterm infection and disease. Both patients and medical staff can be at risk from exposure to laser plumes. When utilizing true cold laser therapy, such as the Lunula device, there is virtually no risk, either to the patient or the treating physician. The worst thing that can happen with true cold laser therapy for onychomycosis is nothing.
Is debridement of the toenail necessary when utilizing laser therapy to treat onychomycosis?
No. During the Lunula studies, no debridement was performed.
What is the standard treatment protocol?
In the clinical trial, treatments consisted of 4 weekly 12 minute treatments.
What are the Advantages of Lunula Low Level Laser for the Treatment of Onychomycosis?
• No chance of developing microbial resistance to this form of treatment
• Does not interfere nor interact with any systemic medicine
• No chance for liver toxicity
• Treatment protocol is painless, ensuring good patient compliance
• No pain during treatment
• No downtime
• Unattended treatment
How does the LunulaLaser work?
Peroxynitrite is a compound that has potent anti-microbial effects. This compound is formed when Nitric Oxide (NO) reacts with Reactive Oxygen Species (ROS). The Lunula Laser by Erchonia, the only true Low Level Laser used to treat onychomycosis, uniquely has two different laser diodes; a 635nm and a 405nm. This combination of wavelengths is crucial in that the 635nm diode produces NO and the 405nm diode is the best producer of ROS, both within the visible light spectrum. Cell destruction is triggered by the cytotoxic effects of peroxynitrite. *NO + ROS = peroxynitrite destroys fungal pathogens* The 635nm laser enhances mitochondrial energy metabolism, which generates NO, and this is combined with the 405nm laser, which generates ROS, produces peroxynitrite. This byproduct is cytotoxic and destroys pathogenic bacteria, fungi and protozoa.
Can a patient become re-infected with fungus once there is clearance?
Yes, patients can become re-infected if they do not take precautions. If a spouse or significant other has clinical nail fungus, it is advised to not treat them without treating their partner. It is recommended for patients to take other precautions to prevent re-infection. Recommendations include, using a gas sterilizer to treat their shoes, using anti-fungal spray to use after wearing closed toe shoes and spray their showers with Tylex or other cleanser, all with the hope of preventing re-infection.
What kind of clinical results are experienced with the Lunula Laser?
Clinical trial results proved and average of 6.1 mm New Clear Nail Growth at 6 Months.