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Onychomycosis and nail dystrophy treated with the PinPointe FootLaserHamish Dow A new modality has become available for the treatment of onychomycosis. I wish to share some results that I have achieved using the new FootLaser made by PinPointe the losing battle against this insidious creates subungual damage, and a nutrient- had some form of empirical testing and disease, which is prevalent in the rich source of decaying matter offers reviews performed by the pharmaceutical population worldwide. Pharmaceutical avenues for pathogens to exploit.
industry. Prescription lacquers and oral companies claim that as much as 12% of Homeopathic and naturalistic remedies remedies are example of OTC medication, the population is contaminated with such as bleach, tea tree oil, vinegar, as are the range of sprays and creams fungal nail disease.
thyme, oregano oil, ClariPro, Zetaclear, overtly marketed as antifungal The two cases I report both suggest Antimonolium Curdum, Aloe Vera and medications. The list includes terbinafine, that tight-fitting shoes can cause mouthwashes rarely work and are mostly itraconizole, fluconazole, clotrimazole, intermittent and prolonged trauma that a waste of time and money. Pharmacology tolnaftate, zinc undecenoate and allows the skin defences to be breached.
is normally the most effective treatment undecenoic acid.
Devitalisation of the local area through for onychomycosis. Over-the-counter The PinPointe FootLaser is the first compressive exsanguination or tissue (OTC) medication is available in outlets medical device to obtain regulatoryclearance (US FDA, EU, Health Canada,Australia and others) for the safe andeffective treatment of onychomycosis. Thereported percentage of patients receivingbenefit from this treatment, 71.4%, issubstantial.1 Treatment with the FootLaseris repeatable, has no systemic toxicity andlaser treatment does not preclude the useof other modalities.2,3 In February 2009, I added the FootLaser to my armamentarium ofremedies against this stubborn andpernicious disease. To date I have treatedover 150 patients. To follow are casereports of two of my patients, both withoutcomes that I have not seen before withother forms of therapy.
Independent analysis of data from 109 photos from 60 of my patients wasperformed in November 2010 anddemonstrated: that, at three months, 67%of all treated toes showed improvement,compared with 80% at six months, 68% atnine months and 84% at 12 months.
Again, the differences over time possibly Figure 1. TOP. Patient 1 as she presented to my office in December 2009 with a clinical reflect different patient populations as well diagnosis and positive mycology of onychomycosis in all 10 toes. She received a single as continued improvement.
treatment on 14 December and a second treatment in October 2010. BOTTOM. Appearance ofher nails at 13 months post-treatment. All 10 toes responded to treatment, most with 100% The patient was an active and dynamic PodiatryNow June 2011


Figure 2. Time series composite of left (TOP) and right (BOTTOM) 1st toes of patient 1. The images show the rate and process of the lesiongrowing out over a period of 13 months.
smartly dressed, 66-year-old female withpronounced onychomycosis anddystrophyic nails on both feet; the right 1stnail (hallux) being the most severelyaffected. It was a condition she foundembarrassing, uncomfortable, emotionallydepressing and cosmetically abhorrent.
In around 2000, whilst out walking in rough adventurous terrain, she damagedboth of her great toes to such an extentshe feared she would lose them. It wouldseem that a combination of poor toeboxspace and slack fastening of the footwearcaused repeated compression of the nail Figure 3. Patient 1 right first toe before (left) and after (right) debridement.
plates, leading to subungual trauma andonycholysis.
Over the next two years she noticed that they never fully recovered to their nothing had worked to eradicate the to keep her review appointments and that former condition but began to ‘look condition and was emotionally worn down she needed to provide a high level of foot worse'. The patient presented to a by the effect of having a disfiguring hygiene and antifungal care to prevent podiatrist in 2008, where routine cutting disease (as she saw it). A medical history recolonisation by opportunistic pathogens.
and thinning of the nails was initiated was documented, her feet were examined The patient was also informed that along with instructions on foot hygiene and an explanation of the modality of the recovery is highly variable from patient to and advice to use OTC antifungal PinPointe FootLaser was explained.
patient. Factors such as trauma, poor preparations. Later in 2008, after lab The patient was reminded of the hygiene, poor circulation, duration and confirmation of dermatophyte infection, options available including severity of the infection, age and general the patient was prescribed oral terbinafine.
pharmacological, surgical and FootLaser. I health may all influence recovery. Finally, I As a consequence of the medication she explained the benefit of a toxicity-free told her that not every condition may developed uncomfortable abdominal approach, the fact that the FootLaser resolve and a secondary treatment may be swelling, giving her the appearance of treatment is largely without any sensation, required in about 15-20% of patients.
being some months pregnant and she is condensed into the treatment time and Following this explanation she consented found it impossible to remain on the has a level of success that surpasses all of to having the treatment.
medication longer than two months.
the topicals and at least matches the The patient's feet were cleaned and By the time she arrived at my clinic in outcome for oral medications, if not more pre-treatment photographs were taken December 2009 she was disheartened that effective. I also explained the need for her (Figures 1 & 2). All nails were debrided to June 2011 PodiatryNow traumatised the tissues. The right 1st toe fitting stylish shoes is what is preventing was displaying a transverse ridge with the patient's recovery from reaching 100%, dense keratinised tissue distally. All lesser or at least preventing accurate visual nails showed greater clarity within the confirmation of 100% clearance.
structure and they cut with a crisp and At this point, the evaluation of the nails clear audible click, indicating improved showed a change in texture vitality and integrity. The left 1ST nail showed a more structure. What was once a fungally normal nail plate production in progress infected, damaged and gryphotic right first and an advancement of contamination toenail has now returned to an almost from the nail matrix of 2-3 mm.
normal nail in every way. The patient is Importantly, the patient was very happy enormously happy with her outcome. I am with the early stages of the treatment. All left with the satisfaction that the PinPointe nails were cleaned and debrided to FootLaser has safely and successfully remove excess keratin and dystrophic treated her fungal infection and in the Figure 4. Continuous increase in percent nail, and photographs taken. The patient process has apparently stimulated a clear nail over a 13-month period.
was instructed to continue with her rejuvenation of the nail bed and tissues in Photographs from each follow-up period antifungal and hygiene care.
the nail root matrix. This is the first time I were computer analysed to quantify the The patient returned in July 2010 for have seen this to occur in my entire career change in area of clear nail. First left toe her 7-month progress evaluation and nail since graduating in 1981.
(BLUE) and 1st right toe (RED). The straight care. Once more photographs were taken, lines are linear regressions fit to the data the nails reduced, onychophosis and that indicate lesion clearing at a rate of subungual debris removed and 1% Patient 2 was a physically active working about 6% of the total nail plate per month.
clotrimazole spray applied. Photographs of male aged 63 with dystrophic and the nails after the reductions were taken.
mycotically infected nails. The infection By now the nails demonstrated significant was clinically restricted to both 1st toes.
what I considered an optimal level. As positive change and the most visually Dermatophyte infection was confirmed by much contaminated tissue needed to be abnormal nail had almost grown out.
InTray DM at day 7 following initial removed as possible and all debris cleared In October 2010, 10-months post- assessment, however his physician had away, including subungual debris. This treatment, the patient requested a second also diagnosed it some time before. He leaves a good working surface that offers laser treatment ‘to be on the safe side,' as was uncomfortable with the thickness of less interference to the laser-energy she put it. I advised that it was unlikely to the nails and also dissatisfied by the discharge and penetration into the tissues.
be necessary but the patient was far physical appearance, particularly in However, this is done in a fashion that happier for me to apply the FootLaser barefoot holiday settings. To the best of his avoids trauma to the vital soft tissues.
again. This time only the margins and a recollection he had had his condition for Photographs were taken again after single pass was performed over all nails.
‘several years'.
debridement (Figure 3).
Photographs were taken pre- and post- During this time the patient had tried a The FootLaser was methodically and debridement antifungal spray applied.
wide variety of topical, proprietary nail meticulously applied to all nails in a 1mm In January 2011, 13 months after the treatments and the condition continued to spot matrix pattern. In addition to the nail initial treatment, the patient once more worsen. He did not consider oral plate itself, the nail margins, nail-root presented for routine care and an medication as an option that he wished to matrices and surrounding tissues were also evaluation. Photographs were recorded pursue due to its restrictions on lased. The treatment area extended from pre- and post-debridement and 1% consumables and the impact that had on approximately 4mm proximal from the clotrimazole spray applied to protect the his lifestyle. Having heard radio eponychium to the end of the nail beds.
area. All nails show increased clarity, advertisements about the new FootLaser, The pattern was repeated twice over each integrity and health (Figure 1).
he arrived for treatment at my clinic on 17 November 2009.
Following the laser treatment, Analysis and discussion His pastimes included competitive terbinafine spray was applied to the nails, I sent my before and after photographs of squash, extensive hill and robust fell toes and interdigital areas and terbinafine the patient's left and right 1st toes to a walking. An examination of his footwear cream was applied to the skin on the research company that uses a trained indicated the need for a larger size but plantar surfaces to help prevent technician and a computer algorithm to complications were created by the recolonisation. The post-care advice was measure the area of clear nail on each narrowness of his feet causing difficulties explained, and an advice sheet given image. The results are presented in in obtaining the best fit, as length is together with antifungal cream and spray.
Figure 4. What is plotted is the percent of sometimes sacrificed for a narrower width A letter was sent to her GP detailing the clear nail measured from each follow-up to ensure better grip on the foot. I treatment and contact made with her photograph before debridement. The left explained the need for improved toebox current podiatrist explaining the toe (blue) appears stalled at the onset, space during the post-laser recovery then, at 7-months it ‘catches up' with the In March 2010 the patient returned for right. Both nail plates grow clear nail at a On examination there was gross a three-month interim follow-up rate of about 6% of the nail plate surface thickening of both 1st toe nail plates examination. At this point and it was per month. This is about the same growth consistent with prolonged trauma and apparent that there were positive rate as the nail plate itself.
substantial subungual debris. This material improvements in the nails, although I also noticed from this analysis that was harvested for culture, which bruising was evident in the nail due to the the clearing seems to stop at about 80%.
patient choosing stylish footwear that Perhaps the continued trauma from tight- contamination by day 7.
PodiatryNow June 2011


Figure 5. Time series composite of left (TOP) and right (BOTTOM) 1st toes of patient 1. The images show the rate and process of the lesiongrowing out over a period of 13 months. A medical history was documented and structural integrity and improved clarity this is certainly not the case since the an explanation of the modality of the within the structure. When cut, all nails patient is extremely pleased with the PinPointe FootLaser explained. Then the yielded a crisp and clear audible click and overall cosmetic improvement. He has had consent forms were completed and pre- had good tensile strength, indicating a lengthy period of time (July 2010 until treatment photographs taken (Figure 5).
improved integrity. Both 1st nails showed March 2011) without any clinical All nails were extensively debrided and all an improved connection to the nail bed at interventions of any type and his nails loose subungual debris removed using the distal margin. The nail on the first toe have continued to show improvement in clippers and Podospray foot drill with on the left foot showed a visible band of texture, clarity and health. The only combinations of tungsten carbide burrs.
3mm width, indicating a difference in its negative I can find is the damage done to The FootLaser was methodically and structure compared with the rest of the his nails from impact from his physical meticulously applied to all nails in a nail. I speculated that this was perhaps activities. I have yet to persuade him that lateral then longitudinal 1mm spot matrix newly re-keratinising nail plate and nail his feet are longer than he thinks.
pattern. The nail margins, nail-root I am impressed with the changes that matrices and surrounding tissues were All nails were cleaned and debrided to occurred in the nails of this patient lased proximal. Treatment began at remove excess keratin and dystrophic nail following one intervention with the approximately 4mm from the eponychium and photographs taken. The patient was PinPointe FootLaser. It has led me to and extended to the very end of the nail instructed to continue with his antifungal believe that the laser has some other (as beds. All 10 toes were treated and hygiene care. The patient was comfortable yet unknown) rejuvenating influence on particular attention was applied to both 1st and satisfied with the look at this early the germinating tissues. Although I have nails. The patient expressed his relief at no direct evidence, my own personal the procedure being entirely painless.
The patient returned in July 2010, 8- experience with the laser and my years as Following the laser, terbinafine spray months post-treatment for his second a practising clinician lead me to believe as was applied to the nails, toes and progress evaluation, and nail care. Once I continue to work with the laser that I am interdigital areas, and then terbinafine more photographs were taken, the nails witnessing treatment outcomes that have cream was applied to the skin on the reduced and onychophosis and subungual not been witnessed before.
plantar surfaces. The post-care advice was debris removed and 1% clotrimazole spray explained, and an advice sheet given along applied. Photographs of the nails after the with antifungal cream and spray. A letter reductions were taken.
1. Uro M, L Uro, M Abrahams, M Abrahams, R was sent to his GP detailing the treatment By now the nails had already Grzywacz. Safety and efficacy of FootLaser and contact made with his current demonstrated significant positive change treatment of onychomycosis in private podiatrist explaining the procedure.
and most visually abnormal nail had practice. Lasers Surg Med 2011; 43(S23): In March 2010 the patient returned for almost completely grown out (Figure 5).
954 (abstr).
2. Abrahams M, Dow H, Grzywacz R, Uro M, a 4-month post-treatment interim On February 11 2011, 15 months Harris DM. Efficacy of FootLaser treatment examination. At this point new following FootLaser treatment the lesions of onychomycosis in 262 private practice photographs were taken, and it was in most nails had completely grown out.
patients. 2011. Pending submission.
apparent that there were positive Yet, the computer analysis on this patient 3. Harris DM, J Strisower, B McDowell. Pulsed improvements in the nails. Although the returned ‘100% infected' due to the laser treatment for toenail fungus. SPIE nails were still thick they showed good persistent whitish discoloration. However, Proceedings 7161A-121, 2009.
June 2011 PodiatryNow

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Osteoporos IntDOI 10.1007/s00198-011-1528-y Skeletal mineralization defects in adulthypophosphatasia—a clinical and histological analysis F. Barvencik & F. Timo Beil & M. Gebauer & B. Busse &T. Koehne & S. Seitz & J. Zustin & P. Pogoda & T. Schinke &M. Amling Received: 14 April 2010 / Accepted: 3 January 2011 # International Osteoporosis Foundation and National Osteoporosis Foundation 2011

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Deaths from Marijuana v. 17 FDA-Approved Drugs (Jan. 1, 1997 to June 30, 2005) http://medicalmarijuana.procon.org/view.resource.php?resourceID=000145 I. Background Much of the medical marijuana discussion has focused on the safety of marijuana compared to the safety of FDA-approved drugs. On June 24, 2005 ProCon.orto the US (FDA) to find the number of deaths caused by marijuana compared to the number of deaths caused by 17 FDA-approved drugs. Twelve of these FDA-approved drugs were chosen because they are commonly prescribed in place of medical marijuana, while the remaining five FDA-approved drugs were randomly selected because they are widely used and recognized by the general public.