evaluation study for the efficacy and safety of pinpointe footlaser in treatment for onychomycosis

Conditions: Onychomycosis of Toenails

Summary: the purpose of this study is to assess the clinical efficacy and safety of the pinpointe foot laser device for the treatment of patients with onychomycosis who have been previously treated with oral terbinafine and failed.

this protocol is designed to demonstrate that the pinpointe footlaser treatment is able to produce clinical improvement treating onychomycosis in patients who have previously taken terbinafine and failed treatment. the duration of enrollment for each subject will be 2 years, with the expectation that this is the time period that will yield 100% reduction in the area of involved nail. enrollment is competitive and we expect to enroll 40 patients at cha. the medical device that is the subject of this clinical trial is the pinpointe footlaser, manufactured by nuvolase, inc. it is a pulsed nd:yag laser device that uses a proprietary pulse train, operating at 1064nm wavelength, with 100 μsec pulses. it received pre-market section 510(k) clearance by the fda and subsequent clearance for the treatment of onychomycosis in 2010. onychomycosis (om), a fungal infection of the toes, is a major health problem around the world. it is estimated that there are more than 40 million sufferers with this condition in the usa. a recent european study showed that the prevalence of onychomycosis may be as high as 26.9%. importantly, it is a particular problem that disproportionately affects diabetics. the main causative agent varies according to climate. dermatophyte infections are common worldwide. preliminary in vitro and in vivo work has demonstrated the proof of principle that the pinpointe footlaser device can kill microorganisms, including dermatophytes and other fungi, which infect the toenail. based on these preliminary results, this study has been designed to demonstrate the efficacy and safety of the pinpointe footlaser for clearing toenails, including those with onychomycosis.

Eligibility criteria:
inclusion criteria: * previous treatment with at least 90 days of oral terbinafine and completed the treatment at least 1 year ago * able to feel a semmes-weinstein monofilament at the tip of each toe * must have at least 50% involvement in at least one great toenail * must be willing and able to present for one treatment visit and two follow-up visits at 6 months and 12 months following initial treatment to photograph the nails * must be willing to apply topical antifungal to the skin surrounding the toes on a daily basis and be willing to spray shoes with an aerosolized antifungal on a weekly basis * must have dystrophic toenails which clinically appear to be mycotic * age ≥ 18 years and ≤ 70 years * willing to comply with study requirements, including regular nail debridement as indicated by the investigator * willing to provide informed consent to participate exclusion criteria: * evidence of gangrene or non-palpable dorsalis pedis and posterior tibial pulses * capillary refill time greater than 5 seconds * patients who are severely immunocompromised (such as in aids, renal transplant regimens, immunosuppressed states consequent to malignancy or agents used in rendering oncologic care, or who suffer from end stage renal disease) * patients with documented diagnosis of psoriasis or lichen planus * actively treating fungal nails with a topical agent during the last 90 days prior to enrollment, including tea tree oil, antifungal nail polish, penlac, fungoid tincture, or similar over-the-counter antifungal treatments * inability to follow treatment regimen or comply with follow-up schedules * history of malignant melanoma or any forms of skin cancers * evidence of acute bacterial infections with or without cellulitis and/or purulence * treatment for onychocryptosis during the last 30 days or a history of recurrent onychocryptosis of at least 3 episodes in the last 12 months in which medical care such as resection by a podiatrist/physician, or use of antibiotics was rendered * toenail deformity associated with trauma, psoriasis or lichen planus