Translation of a-t 2026; 57: 7

Laser therapy for nail fungus?

Laser therapy is a so-called individual health service (IGeL for short, coming from the German name), the costs of which are not covered by the statutory health insurance providers. In October 2025, the IGeL-Monitor* assessed the evidence base for the therapy. It initially used a systematic review² from 2020 on the treatment of adults with a fungal infection of the toenails in which three small, randomised studies on laser therapy with a total of 112 patients were assessed. However, none of the investigations showed results on complete cure as a patient-relevant endpoint.^1,2 The authors of the current evidence report also identified one further relevant randomised study³ including 51 people with a fungal infection of the toenails caused by dermatophytes (the most common pathogen in Germany). In this study, none of the patients achieved complete cure (completely clear nail plus negative fungal culture) after a year using laser therapy, compared to 2 (8%) on sham treatment.³ No studies have been identified for the combination of laser treatment with standard topical or systemic antifungal therapy.¹ In our opinion, the data in the studies are insufficient to assess the adverse effects. The laser treatment is supposed to work primarily by heating of the nail bed, so pain is possible.¹ In one of the investigations, the participants rate the intensity of this on a visual analogue scale (0 = no pain, 10 = worst pain) with a median of 5 during laser treatment.⁴ There are no data on the control group. Overall, the IGeL-Monitor rates the risk/benefit ratio of laser therapy in patients with nail fungus "unclear" due to absence of evidence of benefits and harms.¹ The S2k guideline "Laser therapy of the skin" advises against using a laser as monotherapy in patients with a fungal infection of the nail, but states that combining it with topical or in some circumstances systemic antifungal treatment could be considered.⁵ Costs of EUR 320 to 450 can be assumed for three sessions of the laser therapy alone, depending, among other things, on the extent of therapy provided.¹ In light of the lack of evidence of a benefit from randomised studies, we advise against both monotherapy and combination therapy with lasers, –Ed.

©  arznei-telegramm (Berlin/Germany), January 2026, protected by copyright laws.