you're reading...
evidence based medicine, yeast

Deal or steal? Groupon for laser therapy treatment of toenail fungus

Groupon was recently offering laser treatment of toenail fungal infections for $199. Is this a deal (in some clinics treatment can be $600 to $1000) or stealing your money for a therapy unlikely to work?

Fungal infection of the toenail (onychomycosis) is a difficult to treat condition. The infection causes discolored, bumpy, ugly toe nails that can be hard to cut. The treatment is challenging because the beasties live in the nail bed (the part that we can’t see, beneath the skin). Topical therapies are largely ineffective because they don’t penetrate into the nail bed. The standard treatment is oral anti-fungal medications. The oral medication makes it to the nail bed by traveling through the blood stream, but the down side is the medications have to be taken for 3-9 months. The success rates range from 30-90% depending on the severity of the infection and the medication. High-dose fluconazole (450 mg) taken one a week for 12 weeks seems to have the best success rate (90% cure). Some treatment regimens require blood monitoring and all anti-fungal medications have drug interactions to consider.

So, given the option of taking a prescription medication for months (that might not work in the long run) and the prospect of blood monitoring and potential medication interactions, it’s no wonder people are intrigued by the idea of a laser, especially when accompanied by:

95% effective! Painless! 10 minutes!

The studies with lasers are sparse: 2 published in the world literature as of January 2012. These studies are also small (one study with eight patients and the other with 26 toes!), so that’s not generally an encouraging sign. Another unpublished study, but presented at a meeting, evaluated 39 toenails. These three studies only had short-term follow-up, so while there was “improvement” (meaning 3-4 mm of clear toe nail growth) for 63-85% of toenails at six months and one study reporting a 50% “cure” rate after four treatments with the Noveon laser (the other laser used is the PathoLase PinPointe FootLaser), no study reported on long-term outcome. No study compared laser to the standard oral medications or provided data on long-term safety (the biggest safety concern is damage to the nail bed with temporary or even permanent loss of the nail).

With small studies that are in reality just case series (read: weak studies from which we can draw no conclusions, although they may indicate that further well-designed large studies may be indicated), no long-term data on outcome, and no safety data it’s no wonder that neither laser is FDA-approved for this indication.

So, laser for toenail fungus could be cool cutting-edge therapy, the same outcome as oral medications, a total bust, or even damaging to the toe nail. No way to tell. It’s a total gamble.

But say this is the kind of gamble for you. What else should you consider before taking the leap?

With any “new” medical therapy (really, with any therapy) it’s best to go to an expert. For toenail fungus that’s typically a family physician, a dermatologist or a podiatrist (foot doctor). That way you can get a correct diagnosis and hear about all your options before proceeding with the laser treatment.

Many medi-spas say they are affiliated or helmed by a board-certified doctor, but if the web site doesn’t list the doctor’s name and their specific speciality certification, well, the doctor could be board-certified in ophthalmology or gynecology (would you let a plumber fix the wiring in your house?). And they may really be a doctor, but what if they trained in an off shore diploma factory? Would these things matter to you?

What success rate is quoted? If they’re throwing around over 90% effective! well, there are just no studies (as of January 2012) to back up that kind of claim so it’s hard to call it, um, the truth. Another huge red flag is failing to mention complications. Nothing is too good to be true and nothing is risk free.

My final take is if lasers were really over 90% effective! and risk free! then insurers would probably cover the therapy, and they aren’t. Conventional therapy isn’t cheap. Also, if the results are that amazing, one would think the laser companies would get a few more studies out there. But I never understand Big Pharma, and if they’re already getting people to use the therapy with the paucity of data that exists, well, why make the investment?

And that’s the state of the evidence on laser therapy for onychomycosis.

You decide. Deal or steal?

For more information on treating toenail fungal infections click here

About these ads

Discussion

40 thoughts on “Deal or steal? Groupon for laser therapy treatment of toenail fungus

  1. Dubai may have surpassed that. Now, bear in mind that in the United Arab Emirates, premarital sex and homosexuality are both illegal and check out this link: http://www.groupon.ae/deals/dubai/scientific-clinical-laboratories/2629725?nlp=&CID=AE_CRM_1_0_0_28&a=1910

    Given that expats have to be HIV-negative to get a visa to live in the UAE, perhaps this is meant to be for the locals? In any case, it is the latest unintentional comedy from a country where I lived for five years (and had plenty of premarital sex while I was there…).

    Posted by Georgia Lewis | January 29, 2012, 6:39 am
  2. I think its a rip off. Too much health care is being marketed these days.

    Posted by bob99901 | February 3, 2012, 10:07 pm
  3. Great post, I also wrote a post on this topic more on excess capacity, and entrepreneurship.
    Best Regards,
    Ben
    http://www.benjaminjgoldman.com

    Posted by benjaminjgoldman | March 24, 2012, 3:52 am
  4. An interesting tidbit from a friend’s mother who works in a nursing/assisted living home. She says that some of the people in the community use vick’s vapor rub on their fungal toe nails, but you have to be consistent, and this some how gets the fungus to go away. Sounds kind of like the windex the dad uses in “My big, fat, greek wedding” – but i hear it works! Maybe somebody should do a study. Either way, it’s cheaper than laser treatments!

    Posted by Molly | March 28, 2012, 12:33 pm
  5. I’ve had toenail fungus for 17 years. All ten toes have it now. I actually purchased the groupon deal with a local podiatrist in south Florida. I’ve had three treatments and so far am extremely happy with the progress. Based on my condition, the doctor advised 11 treatments to kill it off. I haven’t worn sandals in 17 years, so $50 a treatment didn’t bother me at all. I was definitely skeptical at first, but after the 3rd treatment, there is actually clear nail growth.

    Posted by Brian | April 14, 2012, 4:42 pm
  6. Hi Dr. Gunter! Came across your blog post and felt compelled to reply. I’ve been challenged by the Grouponification of this treatment as well.

    Full disclosure: I am a podiatrist specializing in foot and ankle surgery; I offer the Cutera GenesisPlus laser for toenail fungus, warts, and varicose veins, consistent with its FDA approval.

    You’re absolutely right that there is a paucity of evidence to support this treatment.

    However, I am aware of several trials currently in progress, at least somewhat blinded and randomized, that support the use of 1064 Nd:Yag lasers to treat this condition. Very preliminary stuff. But they’re happening at academic facilities, under IRB approval. Hopefully the results will see the light of day.

    First and most significantly: Terbinafine is a good drug with a bad reputation, but only among patients. There is lots of good safety and efficacy data to support its use.

    Second: It is important, when counseling a patient regarding a new therapy this expensive, that efficacy data be made infinitely clear, at the risk of violating our public trust. The first laser to market did just that, as they were advertising outside their FDA clearance as far back as 2008. (http://www.nytimes.com/2009/03/20/business/20fungus.html)

    It is my professional opinion that, taking nail physiology into account, multiple treatments over several months may increase efficacy.

    Regarding Groupon, I may be wrong, but my limited understanding leads me to believe that Groupon’s revenue share arrangement violates several CA State laws regarding professional licensees.

    I have seen empirically, tea tree oil, and the menthol in vicks, be used effectively to treat toenail fungus.

    This treatment isn’t a deal; the lasers are HUGELY expensive, and need to be used responsibly in order to provide patient value and good results. I’m not sure that the discount translates into value.

    Hope you find these comments relevant and useful!

    Posted by Bill J. Metaxas, DPM AACFAS | April 23, 2012, 6:29 pm
  7. Dr Gunter

    I read your article on toenail and fingernail laser fungus treatment and I would have to say that I disagree with you. I’m an office manager at a medical practice in Los Angeles, ca. We treat patients In 3 locations for fungus treatment and I would like to tell you the great success that we have had. Typically patients need anywhere from 1 – 3 treatments depending on the severity of the case. In science and in life there is no such thing as 100% gaurentee. I would love for you to contact me personally to show you pictures of patients, come in and see our patients, or put you in contact with our patients. I really look forward to talking to you.

    Posted by Simon | June 15, 2012, 1:27 pm
    • Hello, I am seriously considering this type of treatment to
      cure my fungal infection. I was wondering what kind of laser you
      all use and I would love to see pics if possible of before and
      after results. Thanks for your help!

      Posted by Tenisha | January 16, 2013, 9:05 am
  8. Simon,

    The most important comment you made was that “In science and in life there is no such thing as 100% guarantee”.

    We use the laser in our office as well, and have recently run online promotions. The issue is one of truth in advertising. It is important to cite accurate data when educating patients.

    Patholase/Pinpointe’s early efforts misrepresented their initial FDA clearance, and were the subject of a recent NY Times piece.

    http://www.nytimes.com/2009/03/20/business/20fungus.html?_r=1

    A recent study from Japan, small population, citing an 80% in a small population.

    http://www.ncbi.nlm.nih.gov/pubmed/22453588

    The good news is, these studies are relatively easy to construct, so more and more good data should be available soon.

    Posted by Bill Metaxas, DPM AACFAS | June 16, 2012, 12:02 pm
  9. I would like to add to my June 15 comments. I stand behind our laser fungus treatment. We would not have invested in 3 laser machines and 3 locations if this treatment was FAKE!! The only Dr’s who don’t believe in this treatment are the ones who are too CHEAP to purchase a Laser Machine. I would like to challenge any medical professional to send our office a patient with fungus and if the patient is not cured within 3 sessions there will be no charge. However if the patient is cured you will be responsible for the treatments. Almost any and every laser treatment for any treatment such as Hair Removal, Spider Veins, Facial Rejuvenation, etc. require more than one treatment, if any Dr tells you that only one treatment is required is FALSE!

    Posted by simon | July 17, 2012, 10:35 pm
    • Excellent. It would carry more weight if you published a randomized study comparing laser to fluconazole and placebo. “Stand behind” is not evidence based medicine. People “stood behind” the idea that the Earth was flat until someone proved it wasn’t.

      Posted by Dr. Jen Gunter | July 19, 2012, 5:38 pm
      • You doctors are ridiculous. You believe that if there are no studies then the treatment does not work. Well thousands of anecdotal testimonials show that laser treatment does work completely or partially to clear up nail fungus. The Groupon deal is a great deal. $200 bucks for a treatment that normally costs $1000. and there are no side effects. If it doesn’t work you are out $200. Big deal. It is safer than liver destroying antifungals which you get free cruises prescribe.

        There are hundreds of alternative treatments that mainstream doctors said were not supported by evidence. Mainstream doc tries to discredit probiotics for decades while alternative docs pushed them, Now mainstream docs have accepted the importance of probiotics as supported by recent studies. Sorry, but probotics worked before their effectiveness were proven by studies.

        Posted by Mike | February 23, 2013, 11:06 am
    • Hi, will you treat my nail fungus with the same deal? I’ll pay for it when you cure it?

      Posted by Roy | August 11, 2012, 4:54 am
    • Simon where is your office in LA?

      Posted by theekidicarus | September 22, 2012, 4:50 am
      • We have locations in Century City, Encino, and Monterey Park. You can’t expect toenail fungus to go away after one treatment. There after care instructions that patients need to follow also go best results. Again the Dr s and patients who don’t believe in this treatment are the people who are too CHEAP. If the treatment didn’t work the laser companies wouldn’t be spending so much money for FDA clearance and marketing.

        Posted by simon | July 1, 2013, 4:00 pm
  10. I researched this some after I saw a recent Groupon. It seems that there were several TV news stories in 2009. Perhaps that’s when it first was approved in this country. I don’t know. But it’s very odd to me that 3 years later there’s such a paucity of research data to either back it up or discredit the method.

    Posted by Bob | August 11, 2012, 1:05 pm
  11. I tried the Groupon offer because Laser treatment was the only type of treatment, homemade or prescription, that I hadn’t tried. All the others started to work then quit and the fungus was back. I received my first treatment two weeks ago and the podiatrist stated they will contact me for scheduling the next treatment. I hope it works but the Groupon was a great deal.

    Posted by Tom | August 20, 2012, 12:19 pm
    • Well, I’ve finished all three treatments and my big toe toenails have improved substantially. I don’t know if the fungus is gone but my toenails haven’t looked this good in a long time. The groupon deal was a great deal and the laser process was the best way to go.

      Posted by Tom | August 16, 2013, 2:03 am
  12. definitely a rip off, I have had 5 lazer treatments in 15 months, put lotion on my toes every night and power in my shoes, can not tell any difference at all,. There was even one toe that had a small dot of fungus and it did nothing,
    only thing I rid was $1000

    Posted by Mike Eagle | October 15, 2012, 4:25 pm
  13. Just wanted to share my thoughts on this continually evolving treatment. Here goes:

    The bio-burden within the nail must be reduced to achieve maximum efficacy. The nail thickness must be mechanically debrided, just like a surgical wound. This doesn’t so much make the laser more effective, but minimizes re-infection of the remaining nail plate.

    We’ve also started using a compounded topical of ciclopirox, terbinafine, and fluconazole which has been beneficial.

    The combination of two or three modalities in my practice keeps my efficacy at 80-90% after 6-9 months. That means, after 6-9 months of 1 or 2 treatments, clinically, the nail looks clear, and a nail biopsy or culture shows no evidence of fungal infection/growth.

    Working on a study!!

    Posted by Bill J. Metaxas, DPM AACFAS | November 7, 2012, 1:09 pm
    • Hello Dr. Gutner and faithful readers,

      News from the front: a cursory pubmed search demonstrates three patient studies demonstrating clearance of infection at rates between 50 and 85%.

      http://www.ncbi.nlm.nih.gov/pubmed/?term=1064+onychomycosis

      It is significant to note that none of these studies are using the combination therapy that I believe to be effective; nail is a hard tissue; like bone. We would never consider treating a bone or hard tissue infection without debridement or antimicrobial therapy; so I am at a loss as to why the industry and colleagues think this would be effective.

      Topical treatment in isolation has been shown to have low efficacy. Debridement in isolation has even worse data. Laser in isolation, empirically, is between 50 and 80%. Terbinifiine is safe, and has comparable data – up to 85%. Stay tuned for new drugs from Avacor and Pfizer.

      Nail grows slowly; 1mm per month. That means a nail that is 100% infected from front to back can take 18-24 months to grow out. Often, in moderate to severe infections, debridement is necessary to even quantify that change.

      All our patients have this expectation set; its unreasonable to expect the laser to abracadabra an infection away instantly.

      Long story short, we’re getting better. I think a combination therapy, to include debridement, will prove to be ultimately more efficacious than any therapy in isolation.

      Posted by Bill J. Metaxas, DPM AACFAS | June 23, 2013, 1:55 pm
  14. I started laser treatment in August 2011 for fungus of toenails…today I still have fungus toenail. When I go back to the doctor I am told it takes a year for the nails to grow out!

    Posted by D Right | November 30, 2012, 11:53 am
  15. Touche. Great arguments. Keep up the great effort.

    Posted by wheelercentre.com | December 25, 2012, 1:47 pm
  16. I’ve had two treatments so far over five months and seen no improvement. I’ve applied the oils and creams daily and all they do is stop the nail from growing. Groupon and the doctors who align with them are crooks. Don’t waste your money!!!

    Posted by dan | December 29, 2012, 12:45 pm
  17. The $199 price is actually $599.

    When I called the podiatrist’s office listed in the ad below, they assured me I would not be obligated to pay anything more than the $199 advertised. Relying on that, I bought the Groupon. Later, they said the was an additional $400: $200 for the additional Dr. fee for the 1st visit, and $100 additional Dr. fee for each of the remaining 2 visits.

    Greater Washington Advanced Podiatry – Multiple Locations
    $199 for Three Laser Toenail-Fungus Treatments on Both Feet ($400 Value)

    Posted by pieeconomics | January 27, 2013, 1:32 pm
  18. I bought the groupon for the laser nail treatment about a year ago. All of the nail fungus on my left foot is gone, however my right toe nail is still infected I just went back for a second treatment so lets see if it does the trick this time. For the price this is an awesome deal most doctors charge $1, 000.00 to $1, 200.00 for the procedure. Also the claims that is does not hurt….. in my oppinion are bs the nails can get quite hot and very painful during the procedure. I just sucked it up I will endure some pain to get the fungus removed.

    Posted by nadim | February 3, 2013, 12:30 pm
  19. I am Caucasian and have lived in Asia 30 years and have caught athletes foot there. Never had it, before moving to Asia. It has always been between my outer two left feet toes, NEVER on others. I moved to America and after e few years I caught toe nail fungus on my left big toe. Since it started I have used EVERYTHING ….doctor prescribed expensive LAMISOL pills (bad for your liver) that did NOTHING. Since then it started on my right foot big toe. I cut the nail back sometimes back 80% like 5mm from where it disappears under the skin as the fungus loosens the nail nearly completely. I use and have switched after several month most available most topical anti fungus liquids available in the market every day at least 2-3 times on each nail morning lunch evening (yes I take it to work and apply it in privacy at the restrooms) and STILL nothing has helped. My doctor now recommends to remove the nail completely with an OP saying this would allow the anti fungal topical products to maybe reach the roots area under the skin. The HOT nails due to laser does NOT sound enticing. We don’t want to experience wartime Vietnam where one of the worse tortures was to burn nails! Anyone else out there having a good result with VICKS Menthol and Tee tree oil?

    Posted by vicarious1 | February 27, 2013, 10:36 am
  20. I’ve had toe nail fungus for over 7 years. I’ve tried countless over the counter drugs. None of them worked.

    In managing or attempting to remove the fungus, I’ve maintained my nails by sanding them down as thin as I could stand. Then applying treatment. But still nothing worked. Soaking my foot in vinegar or even bleach nightly it would not remove the fungus.

    I’ve done one treatment. And so far the nails appear to be growing in healthy. My foot would regularly become re-infected with athlete’s foot, and I believe it the source was from my nails. So far my skin on my foot has greatly improved.

    I’ve followed up by buying a UV shoe cleaner, and using over the counter medication to ensure I’m not re-infected. I have a deep spot in my middle toe that I think may need retreating.

    I would not pay $1000 for this treatment, but so far it is worth it to me to give it a try. It’s the best results I’ve seen.

    Also the treatment is not painless. If they move fast with the laser it just feels warm, but if they hold it over one spot too long, it burns. While sanding my toes with my electrical tool, it is a similar unpleasant burning sensation.

    Posted by Kenny456 | March 8, 2013, 11:02 am
  21. I’ve had different surgerys along my 29 years of life and plan on getting treated for other sorts of things. Some by choice and some for health reasons… Never really felt too sure but I’ve gone through with it.. So far I’ve survived everything! Well I’ve had a really embarrassing right foot fungus toe nail for about eight years now Too long to live feeling ashamed.. Of coarse tried prescriptions from doctors and over the counter medications nothing has worked.. So today I decided I’m going for it, I’m doing my first laser treatment.. My appointment is set up this same week and same day treatment I will be posting how its looking after some time and when i get my other treatments.. I say if you go based on what people post and dont go out and do it you’ll never know..

    Posted by Araceli E | April 16, 2013, 12:53 am
  22. Dr Gunter,

    Thanks for the article, it is full of interesting thoughts on laser fungal nail treatment. I have also enjoyed reading the comments, which show how opinions differ (sometimes quite a lot!) on this treatment.

    I have written a few articles on topical fungal nail treatments that your readers may find useful as an alternative to laser treatment.

    Thanks again for the interesting article.

    Posted by Fungal Nail Treatment | June 19, 2013, 4:08 am
  23. Groupon Laser treatment. $250 per session.. So far 2 sessions, results, not so good. I cannot see any improvement. I also used a UV shoe device, which actually works quite well (for the shoes). I also apply formula 3 daily. I am getting discouraged. I have 3 nails infected. Dr. is asking if I want to try oral meds. Like everyone here I want it gone., like everyone here I’ve tried bleach, vinegar, Vicks, etc…no luck for me.

    Posted by Billy Smith - not | June 22, 2013, 5:03 am
  24. You really have done a disservice to your readers… You are obviously under informed (ignorant) to the success of laser treatment. I have seen it… It does work without pain or the use of known harmful drugs… You need to do your homework.
    How are you associated with the drug company’s ? You must be, because your disparagement is very blatant.

    And so you know… I am not a doctor, nor a nurse… However I have seen the success of what lasers can do for individuals with this condition.
    You make me remember the early days of chiropractic & how you or those like you tried to sell it as snake oil… Funny… It sure has helped many people & kept them from becoming victims of harmful drugs.

    Put that in your pipe & smoke it Missy…

    Posted by Cowboydoug | August 14, 2013, 3:22 pm

Trackbacks/Pingbacks

  1. Pingback: Should I Try A Laser Toenail Fungus Surgery Deal From Living Social? - SteriShoe Blog - Are There Cheap Remedies For Toenail Fungal Infection Or Is Good Laser Foot Fungus Removal Always Costly? - June 7, 2013

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Recent Tweets

Follow

Get every new post delivered to your Inbox.

Join 773 other followers

%d bloggers like this: