So the nail fungus must be treated properly – treatment with home remedies, medication, tablets, laser and further therapies. More information here.
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Nail fungus is widespread in Germany. About 20 percent of Germans, from the age of 65 even up to 45 percent, suffer from this disease. A fungal infection of the toenails, and more rarely also the fingernails, is not painful, but it is very stubborn and also not nice to look at.
Fight nail fungus with nail polish, tablets & Lasers
Depending on the severity of the infestation, age, possible other diseases and general nail growth, the treatment can last for several weeks, months or even years. So-called filamentous fungi are usually the cause of the pathogen, but yeast and mold fungi can also cause the infection. These types of nail fungi exist.
Why can’t the body defend itself against the fungus?
Nail fungi nest in and under the nail plate and feed on the keratin, the building material of the nails. The human immune system is relatively powerless against the invaders because it works through the bloodstream and so-called scavenger cells, which absorb them and render them harmless. However, since the horny plates of the nails are not supplied with blood, the immune system does not work with this type of fungus and it can and will spread undisturbed.
What helps against the fungus?
Although a great many people are affected by nail fungus these days, it seems to be a very shameful topic. Hardly anyone is open to it, and women in particular can cover up the supposed blemish very well for a long time with colored varnishes.
Treatment, especially in the early stages of the fungal disease, is very simple and should definitely be done as quickly as possible to prevent the fungal infection from spreading to other nails and not to become a source of infection for to serve other people.
Fortunately, there are many helpful remedies to combat nail fungus. As a rule, these are special medical anti-fungal nail polishes or tablets. Natural products and home remedies can also help to heal. The type of treatment depends on how far the infection has progressed.
1. Consult a dermatologist
If there are any suspicious changes in the nail, a dermatologist should be consulted first. Because treatment only makes sense if the discoloration is actually caused by a fungal pathogen and if this is precisely determined.
2. Create diagnosis – pathogen detection
In most cases, a visual diagnosis is not enough to determine nail fungus. The accuracy is only 50 percent. The traditional methods, namely microscopic observation and culturing, are much more accurate.
In order to get a nail sample, the dermatologist first disinfects the affected nail with a 70% alcohol solution. Then he cuts one or more tiny pieces off the nail and looks at them under the microscope. If the sample is identified as a nail fungus, the doctor then creates a fungal culture in order to identify the exact pathogen. The accuracy is about 70 percent. The further therapy depends on this typing. The result of the pathogen detection is available after about 3-4 weeks.
In the case of severe advanced nail fungus disease, immediate treatment with a broad-spectrum antifungal preparation, which is effective against various types of fungi, is often started. If the final result is then available, the nail fungus is treated specifically and systematically with the right medication.
There is now also a genetic test who can examine the nail samples for a fungal pathogen. With an accuracy of 87 percent for filamentous fungi, this should be even more precise than the classic examination using a culture or microscope. The advantage: the test results are available after a maximum of 3 days.
If a microscopic examination is not possible due to pre-treatment of the nail or if there is no clear diagnosis of nail fungus despite clear symptoms, a histological examination with PAS staining should be carried out.< /p>
Nail Fungus Treatment & Therapy
Once nail fungus has been diagnosed, the often lengthy therapy begins to get rid of the unwelcome companion. This can be done in three ways:
- External treatment: nail polishes
- internal treatment: tablets
- Treatment with laser
Once nail fungus has been diagnosed, the often lengthy therapy begins to get rid of the unwelcome companion. This can be done in three ways:
The therapies can and sometimes even have to be combined with each other in order to achieve the greatest possible success. The degree of infestation, mild or severe, will dictate the type of treatment.
In general, the affected nails should be regularly trimmed to a minimum as they are a source of infection. If the nail plates are already crumbly, you can carefully smooth the surfaces with a fine file. It is only important to either disinfect the tools used very thoroughly after use or to replace them with new ones, such as files. Disposable files are advisable in such cases anyway.
In order to combat toenail fungus in the best possible way, a pedicure by a podiatrist is recommended. They can professionally prepare the nail for further therapy in their foot care studio.
Treatment for mild nail fungus infestation with nail varnish
A mild fungal infection is present when only the outer parts of the nail plate are affected (maximum 30-50%) and the nail growth zone (nail matrix) is not infected. In such cases, a topical (local) treatment with a medical nail polish is promising. The anti-fungal nail polishes are available without a prescription in every pharmacy.
What are the fungicidal nail varnishes?
There are different types of antifungal nail polishes with different active ingredients.
- waterproof varnish with the active ingredient amorolfine (e.g. Loceryl, generics)
- waterproof nail polish with the active ingredient ciclopirox (e.g. Nagel Batrafen)
- water-soluble nail polish with the active ingredient ciclopirox (e.g. ciclopoli against nail fungus)
When treating with a waterproof nail polish, the nail is applied once or twice a week. Previously, each time it is necessary to clean it with an alcohol swab, and roughen the part of the nail affected by the fungus with a disposable file. This is the only way for the active ingredient to penetrate the nail optimally.
If the anti-fungal varnish is water-soluble, it must be applied daily to the infected nail, preferably in the evening before going to bed. Remnants of the paint can simply be washed off with water before reapplying.
Depending on the active ingredient, the fungal pathogens and fungal spores are combated with different modes of action.
Ciclopirox active ingredient
Effectively combats filamentous, yeast and mold fungi that are the cause of nail fungus.
The active ingredient ciclopirox was patented by Hoechst AG in 1970 and 1975 and has since been approved as a medicinal product. The drug is used as a local antifungal and is the cause of nail fungus.
Ciclopirox disrupts the fungal membrane and prevents the absorption of important cell components into the fungal cell. It also has a spore-killing, anti-inflammatory and antibacterial effect.
Possible, but rare to very rare side effects are:
Skin irritation at the edge of the nail or on the nail bed, such as dryness, flaking, burning, redness or itching.
In the event of a hypersensitivity reaction to the active ingredient ciclopirox, the treatment must be discontinued and a new therapy discussed with the doctor.
Ciclopirox is available as an active ingredient in both waterproof and water-soluble nail polishes.
Active substance amorolfine
Amorolfine has fungus-inhibiting to killing effects on dermatophytes, yeast fungi, molds and dimorphic fungi. The drug is successfully used to treat fungal nail and skin diseases.
The active ingredient amorolfine interrupts the nutrient supply of the fungus and thus inhibits fungal growth. This means that the fungus can no longer grow and multiply. If the concentration of active ingredient is high, it also kills the fungus immediately.
Possible but rare to very rare side effects are:
Skin irritation (itching, scaling, redness) on the edge of the nail or on the nail bed.
Which nailpolish works best? Studies
There are a large number of studies comparing water-soluble and water-insoluble nail polishes, but also examining the active ingredients ciclopirox and amorolfine.
However, the database and the methods differ enormously and cannot be compared with each other. The studies are inconsistent overall and therefore deliver different results. Sometimes one method is better, sometimes the other.
One cannot therefore say that the waterproof amorolfine varnish is better than the water-soluble ciclopirox varnish or vice versa.
Both nail polishes have a fungicidal, fungiastic and sporicidal effect when used correctly and thus support mycological healing. However, patience and a high degree of conscientiousness are required for the often very lengthy treatment period.
Nail fungus therapy with bifonazole cream
In addition to fungicidal nail polishes, it has also been possible for a number of years to treat mild to moderately severe nail fungus with a concentrated cream made from urea (urea) and the broad-spectrum antimycotic bifonazole (Canesten Extra Nagelset, Bifon Gel from dermapharm AG Arzneimittel, Canesten extra nail set)). Bifonazol works well against dermatophytes (thread fungi), yeast and mold and is also anti-inflammatory and antibacterial.
This 2-phase therapy is carried out over a period of 6 weeks. A kind of pre-treatment takes place over a period of 1-2 weeks with an ointment containing the active ingredients urea (40%) and 1% bifonazole). After that, another ointment with the sole drug bifonazole (1%) is applied over a period of 4 weeks.
Application for approx. 1-2 weeks with urea and bifonazole
After a 10 minute, warm water bath, the nail surface is thinly coated with the ointment. The uric acid contained in the cream dissolves the infected nail layers and thus makes them permeable to the antifungal agent. This effect is reinforced by a patch that is stuck over the treated nail. After 24 hours, the patch is removed and the affected toes or fingers are re-soaked in warm water for 10 minutes.
Then the nail layer is so soft that the fungus-infected part of the nail can be removed as much as possible using a spatula included in the set. Since the medicinal substances contained in the cream only act on the diseased nail substance, healthy parts of the nail remain unaffected. The ointment is then applied again.
This procedure must be continued until all mycotic nail parts have been removed. The nail bed must be smooth for further treatment. This is the case after about 7-14 days, depending on the severity of the fungal disease. If the treatment is not successful within this time, please consult a dermatologist.
Follow-up treatment for 4 weeks with a 1% bifonazole cream
The nail is then treated with a 1% bifonazole cream (without urea) once a day for at least another 4 weeks. A plaster is no longer required.
In clinical studies, 87 percent of the patients confirmed that the nail set was very effective or good. Only 3.2% of users experienced slight local skin irritation.
Treatment for advanced_stage of fungal disease
Nail mycosis is advanced when it has not only affected the outer edges of the nail or the nail plate, but also the nail matrix (nail root) is affected. So the lower part of the nail where it grows out. This means that every new piece of nail that grows back is automatically affected by nail fungusand can no longer be reached by the externally acting nail polish.
At this stageOnly a combination of external (nail polish) and internal use (tablets) helps. This type of anti-fungal therapy is much more effective than a purely external treatment. The healing rate is up to 70 percent.
Since there are different types of pathogens that trigger nail fungus, it is essential to consult a doctor who will determine the exact pathogen and then select the right drug. (What to do in the event of a fungal infestation?)
Tablets and their effect
Tablets act via the gastrointestinal tract and are absorbed there via the mucous membranes into the bloodstream. The fungicidal active ingredients are not only absorbed locally where they are needed, i.e. in the nail matrix, but they act throughout the body. It is therefore a so-called systemic therapy.
This is sometimes accompanied by a large number of undesirable side effects and possible drug interactions if the person concerned has to take other medication.
Important: In the case of tablet intolerance, treatment can also be carried out with a special laser.
The length of time the tablet is taken varies depending on the active ingredient and in most cases has to take place over a period of several weeks to a year until the new, non-fungal infected nail has grown back.
The antifungal tablets ALWAYS require a prescription. Even if you can buy everything on the internet these days, including over-the-counter nail fungus tablets, you shouldn’t save at the wrong end for the sake of your health, because you shouldn’t every tablet is effective against every nail fungus.
A distinction is made between 3 essential active ingredients:
- Terbinafine (mainly in filamentous fungi)
- Itraconazole (also for yeast and mold)
- Fluconazole (if the other active ingredients are unsuccessful)
If you stop taking the tablets prematurely, (renewed) outbreaks of nail fungus are to be expected.
The most commonly used and most effective drug is terbinafine. This antifungal is taken in tablet form once a day for a minimum of 3 months and inhibits and kills nail fungus.
The drug terbinafine damages the fungal membrane, which means that it can no longer absorb and utilize nutrients. As a result, the nail fungus starves and gradually dies off.
Unfortunately, the following side effects occur occasionally (at least in 1 in 1000 patients):
- gastrointestinal complaints (nausea, vomiting, abdominal pain, diarrhea)
- Loss of appetite
- Joint and muscle pain
- Liver damage
- Changes in blood count
- Flu-like symptoms
If you have any symptoms that occur during treatment, please contact your doctor or pharmacist.
Treatment with terbinafine tablets should be avoided if you have the following pre-existing conditions or restrictions:
- already damaged liver
- Allergy to an active substance
- impaired liver or kidney function
- Psoriasis (psoriasis)
- Weakened immune system, e.g. due to chemotherapy or cortisone treatment
- Pregnancy and lactation
- under the age of 18
The active ingredient itraconazole is an alternative to terbinafine, but is slightly less effective. It is taken either as an interval therapy or as a continuous therapy over a period of 2-3 months.
Daily intake of 2 capsules after meals for a period of one week with a subsequent break of 3 weeks.
take two capsules twice a day after meals.
The success of the tablets is based on the active ingredient interfering with the cell membrane of the fungus. As a result, this membrane loses its functionality and can no longer absorb nutrients. She’s starving.
Rarely (in at least 1 in 1000 patients) the following side effects occur:
- Liver damage (very rare)
- Stomach and intestine problems (nausea, vomiting, abdominal pain)
- Loss of appetite
- Hair loss
- dark urine
- light chair
Treatment with itraconazole tablets should be avoided if you have the following pre-existing conditions or limitations:
- Heart failure or pre-existing conditions that favor heart failure
- already damaged liver
- Allergy to an active substance
- Allergy to dyes (e.g. E 104 and E132)
- restricted kidney function
- tendency to edema (water retention)
- Intolerance to sucrose (important for diabetics)
- Pregnancy and lactation
- younger than 18 years or older patients (the manufacturer does not specify an exact age)
Tablets with the active ingredient fluconazole are only useful for the treatment of nail fungus if previous treatments have been unsuccessful or cannot be used due to other indications, such as drug interactions. It must be taken over a period of at least 6-12 months.
The dosage depends on various factors and must therefore be discussed with a doctor. There are various interactions with other medications, so a careful medical history should be taken before taking it.
Fluconazole is generally well tolerated, but the following side effects occur in at least 1 in 1000 patients:
- gastrointestinal complaints (nausea, vomiting, abdominal pain, constipation, flatulence)
- Loss of appetite
- Dry mouth
- Skin reactions (itching, hives, rash)
- Kidney dysfunction
- Liver damage (hepatitis, liver failure, jaundice)
- feeling weak
The list is not final.
Nail fungus tablets and alcohol?
So far, there are no clear scientific results that link drinking alcohol to nail fungus therapy with tablets. However, there are some experts who recommend a low-sugar (low-glucose) diet to help with toenail fungus, as it may inhibit the pathogen from multiplying. Sugary alcopops should therefore be avoided.
An infrequent glass of wine or beer on special occasions should, however, be allowed during systemic therapy with tablets.
Nail fungus treatment with laser
The use of a laser for the targeted treatment of nail fungus is a relatively new method that has only been used more and more since 2010. Usually when therapy with antimycotic tablets is not tolerated or other indications such as pregnancy, breastfeeding, children, other diseases, immune deficiency, etc. are present.
The evidence on the effectiveness based on studies is still relatively thin and medically controversial. The number of study participants has so far been too small, the duration of the study is too short and the methodology is different.
It is unclear, for example, whether the laser grabs the nail fungus at the proverbial (nail) root or whether the very resistant fungal spores survive the heat of the laser and the fungal infection breaks out again as a result. A sole treatment exclusively with laser light will therefore hardly be sufficient to ban the fungus permanently. In combination with a medical anti-fungal varnish, however, the chances of recovery are good.
Effect of the laser on nail fungus
How exactly the laser affects the fungus has also not yet been clearly clarified in science. One assumption is that the fungi are killed by the heat of the laser (fungus filaments die off at around 60 degrees) or the associated evaporation of the water. However, since fungal spores are very heat-resistant, they could survive the laser treatment. They only die off at a temperature of around 80 degrees and no laser can achieve that. Special wavelengths of laser light may also release free radicals that kill the pathogens and spores. It is also conceivable that YAG lasers only have a temporary effect on the nail fungus and only suppress or inhibit it for a while.
Since the corresponding nail fungus lasers are quite expensive to buy and the therapy is not yet scientifically evident, not many dermatological practices offer such a treatment. In addition, the statutory health insurance companies do not cover the costs of the treatment.
Which lasers are suitable?
There are different types of lasers that can be used for toenail fungus, including:
- YAG laser
- Yttrium Laser
- Diode laser
- Ablative Lasers
- CO2 laser
The most widely studied laser in studies is the YAG laser. But all other types of lasers that are approved in Germany for the treatment of onychomycosis can also be proven to fight the fungus.
Interesting to know; the manufacturers did not have to prove a cure by the laser. Evidence was sufficient for approval that the laser is effective against nail fungus.
Procedure for laser treatment
Before laser therapy is used, the affected nail or nails must be prepared for the treatment. If the affected nail is thick and discolored, the affected nail plate should first be ground and smoothed with a cutter.
This is done either as part of a medical pedicure or on-site with a dermatologist. However, this varies from practice to practice and can be clarified with the doctor over the phone.
Before the laser is used, the affected nail is first disinfected. The affected treatment area is then irradiated for a few minutes. The patient may feel a slight burning or tingling sensation. However, the laser itself is harmless to the skin.
Duration of laser treatment
A one-time treatment is certainly not enough to combat nail fungus (nevertheless, that’s how it’s communicated, at least in some parts of the United States). The nails have to be repeatedly irradiated with the laser over a period of several weeks up to a year.
This also depends heavily on the individual case and the severity of the infestation. In the case of a severe nail fungus infestation, at least 8 sessions are required, lighter cases can be treated with about 4-6 sessions.
The sessions take place at intervals of between one and 4 weeks and last between 15 and 60 minutes, depending on the application.
An advantage of laser treatment lies in the very few side effects and it is virtually painless. A slight burning sensation, tingling or stinging can only be felt during the irradiation. However, these symptoms disappear once the treatment of the nail is finished.
Cost of laser treatment
The costs for laser treatment for nail fungus are not covered by statutory health insurance. Depending on the number of nails affected and the severity of the fungal infestation, these are around 80-500 euros per session. The numbers vary greatly from region to region.
However, some private health insurance companies contribute to the costs. Clarify this in advance with your insurer.
Conclusion of laser treatment
Even if there is no reliable evidence that laser therapy is effective, it does not mean that it does not work. However, it should definitely be done in combination with an antifungal nail polish to increase the chances of a complete cure.
Nail fungus home remedies – useful or not?
This question can be answered clearly and very briefly and concisely:
Fighting or even curing nail fungus with home remedies is a waste of money and time because it is ineffective.
A nail fungus treatment should always be treated immediately with a suitable medical nail polish to prevent the pathogen from progressing and spreading to other nails.
Although various home remedies are said to work against the stubborn nail fungus pathogen, above all vinegar or vinegar essence, these rumors should not be believed. Worse still, it can cause allergic reactions and skin irritation on the nail, further exacerbating the problem.
In addition to vinegar, “miracle cures” circulating on the Internet include tea tree oil, coconut oil, manuka oil, baking powder, your own urine, toothpaste, lemon juice, lavender oil, sage tea, garlic, olive oil, thymoan oil, oregano oil, alcohol, Epsom salt, natural yoghurt, brine, calendula, baking soda , grapefruit seed extract, horseradish, oak bark stock, homeopathic globules, Schuessler salts, etc. The creativity of some websites knows no bounds. You might as well dance around a tree three times while yelling, “Nail fungus go away.” This has roughly the same effect.
No matter which home remedy you choose, not a single home remedy has been scientifically proven to be effective.
Of course, there are substances among them that do indeed have an antifungal and antibacterial effect, but still fail miserably with such a stubborn pathogen as nail fungus. This is not only due to the extremely resistant filamentous or yeast fungi and their fungal spores, but also to the very protected area, namely under the nail plate or even in the nail root itself, where the infection spreads. Non-medicinal agents simply do not penetrate through the nail to the actual site of infection. If you actually want to try a home remedy, you are wasting valuable time in which the fungus can continue to spread undisturbed.
If you have nail fungus, do not hesitate to visit a dermatologist or a podiatrist and discuss how to proceed. The sooner you do this, the quicker you’ll get the fungus under control.
Even if all toes are already affected and you are ashamed of your appearance, we recommend that you see a doctor. The treatment of advanced onychomycosis is tedious because the nail plate has to grow out completely healthy, but it is worth it. With the right medical treatment, the nails will soon grow back healthily and you will be able to show beautiful feet and toenails again in the following year at the latest. Persistence is very worthwhile in this case.
Which treatment is right for me?
The treatment of nail mycosis depends not only on the severity of the infestation, but also on the needs of the patient.
You should ask yourself the following questions:
- Is the problem purely cosmetic and how much does complete cure of nail fungus mean to you?
- Are you very consistent and motivated?
- Would you like to apply the nail polish every day or once or twice a week?
- Would you be willing to take pills despite frequent side effects?
- Are you willing to pay the cost of therapy over a long period of time?
- What is the probability of getting nail fungus again?
You should first answer these questions and your thoughts or even concerns about them yourself and then express them in a conversation with the treating dermatologist.
You are the most important part of therapy. The success of the treatment stands and falls with your conscientiousness.
How long does a nail-fungus-treatment last?
A nail fungus disease is annoying and, above all, very persistent. This is mainly due to 3 factors:
- Nature of mushrooms
- Nail growth
- Inconsistent treatment
Fungi spread via tiny fungal spores, i.e. the robust survival form of fungi. Unfortunately, the spores of the most common nail fungus, the filamentous fungus Trichophyton rubum, are considered to be particularly resistant. They easily survive temperatures between -20 degrees and +80 degrees, as well as aridity and extreme drought.
The treatment of nail fungus must therefore not only target the fungicidal (fungicidal) effect, but also the spore-killing (sporicidal) effect.
If even one spore survives, a relapse is almost inevitable.
Growth of fingernails and toenails
A diseased nail is only considered cured when it has grown back completely healthy. Fingernails typically grow about 3mm per month, about twice as fast as toenails, which only grow about 1mm per month. A little faster in the summer, a little slower in the winter months.
A fingernail needs about 6 months to grow back completely. In the case of toenails, this time increases by at least another 3 to 6 months. A toenail needs up to a year to renew itself once.
The sooner you start treatment, the greater the chance of recovery.
Careless treatment – app as a mobile help
During the entire treatment period, the fungus and its fungal spores must be combated relentlessly for several months. This requires a lot of patience and perseverance.
The recurrence rate for nail fungus is extremely high, which is partly due to the stubborn fungal spores and the many opportunities for reinfection. Even if the nail looks healthy again, the treatment with special antifungal nail polishes should be continued for some time.
In order to support the therapy and not to become careless, there is now a therapy-accompanying app for smartphones (Springer -Coach Nail Fungus), which reminds the patient of the next treatment step. What is already common practice for diabetics also helps to combat and cure nail fungus.
Important: Always disinfect your shoes and ideally buy new socks.
What happens if the fungus is not fought?
If nail fungus is allowed to grow uncontrollably, it will spread to all nails and even lead to nail deformation over time. The nails are getting thicker and the nail plate is slowly coming off. This not only looks scary and can sometimes be painful, but is also a source of infection for all other people, because the wearer will only throw infected skin flakes around, in a figurative sense. The nails become crumbly and these tiny scales are spread everywhere.
Can one completely cure nail fungus?
Yes, nail fungus can be completely cured in most cases, BUT…
In some cases one should consider whether one prefers to grow old peacefully together with the nail fungus. Treatment with fungicidal nail polishes, but also with tablets that act from the inside, is extremely lengthy and there is a high relapse rate.
Especially older patients with poor circulation and slowly growing nails have poorer chances of recovery and the fungus itself can be contained well with special nail polishes and regular foot and nail care.
Even in people who suffer from serious illnesses or who have to take strong drugs that weaken the immune system (cortisone, chemotherapy, etc.), it is difficult to completely eliminate the fungus.
One should therefore consider whether absolute freedom from fungi is desirable at all or whether there are important medical reasons that require the complete killing of the fungus.
Treatment of nail mycosis is absolutely necessary, but complete freedom from fungi is not an absolute must.
Avoid recurrence after nail fungus cure? Prevention
Unfortunately, the recurrence rate, i.e. the recurrence rate, in nail fungus is relatively high. This is essentially due to the extremely resistant forms of survival of the fungi, the fungal spores.
The second important factor is the patient himself and how he deals with the nail fungus pathogen. There are a number of essential measures that can at least minimize the risk of reinfection.
These tips will help keep nails healthy:
- Disinfect all shoes and clothing, towels and socks that may have come into contact with toenail fungus. There are special fungicidal sprays or detergents for this.
- It is best to wear cotton socks and change them daily
- Use a separate towel for your feet and change it every day.
- Only wear well-fitting, non-restrictive footwear that is breathable at best.
- Also treat athlete’s foot immediately, as it is the same strain of fungus that can spread to the nail.
- Let your feet out in the fresh air and always dry them very well.
- Always wear flip-flops in barefoot areas.
- Apply a drug-free nail polishon healthy nails. This serves as a prophylaxis and protects the nail from the penetration of the nail fungus pathogen.
- If you are prone to fungal infections due to illness (e.g. diabetes mellitus), you should treat your feet with an antifungal foot spray after every visit to a public barefoot area (swimming pool, sauna, changing rooms, etc.). , which specifically kills both nail and athlete’s foot fungus.
If the fungus does return, act immediately by fighting it with the active ingredients that have already been tried and tested.
Ärztezeitung.de: Combined therapy is often necessary for nail fungus
Pharmazeutische-Zeitung.de: Laser as a new treatment option
drbesser.de: Laser against nail fungus
Ärzteblatt.de: Onychomycosis: Higher healing rates and shorter duration of therapy
AWMF online (working group of scientific medical societies): onychomycosis
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