Are you dreading sandal weather because one or more of your toenails has turned ugly? If the nail is misshapen, thickened, crumbly and/or discolored with yellow, brown or white splotches, chances are that you have a fungal infection. It’s caused by microscopic critters called dermatophytes that get under the nail and multiply.

These nasty infections are notoriously difficult to treat. Topical antifungal products often don’t work…and oral antifungal drugs can cause diarrhea, rashes, retinal problems and potentially deadly liver damage! So it’s good to hear that there’s a new approach to treating toenail fungus. Though published studies are somewhat limited, early results show the technique to be safe and effective. The secret weapon: Laser.

According to Jonathan D. Rose, DPM, a podiatrist in Baltimore and coauthor of The Foot Book: A Complete Guide to Healthy Feet, a number of podiatrists are now using the Nd:YAG or a similar laser to treat nail fungus. The pen-shaped device emits laser energy that penetrates the nail and produces moderate heat deep within the underlying dermis as well as the nail tissue. This inactivates the dermatophytes and renders them unable to reproduce. Treatment takes several minutes per nail…involves mild discomfort (a level that Dr. Rose termed “tolerable without anesthesia”)…and causes no side effects. Patients can immediately return to their normal activities, including sports.

One to four sessions may be required, depending on infection severity. Treatment does not immediately fix the appearance of the nail—the damaged nail needs time to grow out, which takes six to 12 months—but if the laser worked, you’ll see the new nail grow in normally. Dr. Rose estimated the success rate at 70% to 90%. The cost ranges from about $500 to $1,500, depending on your location and the extent of the treatment required. Unfortunately, it generally is not covered by insurance.

With toenail fungus, there is always a chance of a recurrence. “Shoes create a dark, warm, moist environment conducive to fungal growth. Also, feet sustain ‘microtraumas’ from daily use—particularly if you wear shoes with narrow toe boxes or high heels—and tiny injuries allow fungus to get back under the nail,” Dr. Rose explained. To minimize that risk…

  • Never go barefoot in shared bathrooms (such as at the gym)—instead, wear flip-flops, Crocs or something similar even when showering.
  • Scrub your feet when you bathe, then dry them thoroughly, especially between the toes.
  • If you have perspiration-prone feet, change your socks often and avoid tight shoes.
  • Spray the insides of your shoes with a disinfectant, such as Lysol.
  • After your last laser treatment, your doctor may advise you to use a prescription or nonprescription topical antifungal medication on the affected nail daily until the damaged nail has completely grown out.