There are many lasers coming onto the scene for treatment of fungal toenails. While all are FDA approved for podiatry and dermatology use, there still has not been a laser approved strictly for fungal toenails or onychomycosis. The Noveon laser by Nomir medical had claimed that it would be approved but it recently ran into stumbling block with the FDA. So their FDA approval is in question.
Based on this uncertainty, I have resumed my research for the best possible laser option for my patients. I am still of the opinion that the Nd:Yag laser in the 1064nm spectrum is not the best option. This is especially true of the Pinpointe which has a small spot size that can lead to a problem known as stacking. Stacking comes from overlapping of the laser beam in the same area possibly leading to burns and damage. Small spot size can also lead to missed areas of treatment. I also do not like the fact that the procedure is performed manually with minimal control of the beam distance. The current single treatment with Pinpointe has also come into question. There is increasing evidence that to be effective, two or even three treatments are necessary.
So, I will continue my search for the best treatment options for my patients. Ideally, I would like a laser that has a 10mm spot size allowing for even treatment of the complete nail with a beam the covers the whole nail. Also, I like the idea of a cooling system integrated to prevent excess heat. So I may be close to finding the laser that combines the best of the Noveon and the best of the Pinpointe without their negatives. The CoolTouch lasers have many of these features and are available in wavelengths other than 1064.
All told, lasers may only have general FDA approval for podiatry and dermatology and no specific FDA approval for onychomycosis. However, there will still be significant value in the treatments compared to the current available treatments.
So keep watching for updates as new research unfolds!