Clearanail, is the 'silver bullet' for fungal nail treatment globally, says Dr. Thomas, with results evident within two weeks. 

While Clearanail is available in the UK for some time, this has yet to make an impact on the health-care consumer in the US, where demand is often client- driven, after marketing in the newspaper, TV & radio commercials etc. 

The US distributor, the very enthusiastic Dr. Zuckerman hails Clearanail as "the next biggest development" in the management of the mycotic nail, offering a patient a "one-off treatment and cure" option. Clever engineering allows the clinician to create multiple 'micro-pores' without pain. His is a vision of multi-media, mass marketing. He can't get the units fast enough to satisfy demand. The inventor, Dr. R. Thomas, a PhD robotics engineer, struggles to adapt the manufacture and distribution network fast enough to accommodate the demand, according to US sources. Not only is this a revolutionary development, but we have the research evidence, says Dr.Zuckerman. 

So, can Clearanail live up to the hype? Early adopters of Clearanail report encouraging results but find better results in the great-toe nail, with poorer outcome in lesser nails. It is unclear, yet, if the treatment can be effective for all types & grades of mycotic infection. To the best of my knowledge there are no randomized, prospective trials published, as yet. 

Clearanail is a technologically enhanced version and better tolerated trephine technique. It is, in essence, a means to improve drug-delivery to the affected nail and nail bed, via 'micro-pores'. The delivery of up to twenty, 0.4mm micro-pores, is permanent and somewhat visible, but not a cosmetic disaster, until the nail re-grows. 

Effectiveness of the treatment will, ultimately, remain dependent on good patient compliance with daily application of anti-fungal medication. And re-infection will always remain a risk that will require from a patient preventative care for skin, footwear and hosiery. 

A fee-paying patient lured by marketing will have high expectations. A silver-bullet will offer a patient a one-off, immediately effective and permanent cure of the infection with restoration of a healthy, cosmetically appealing nail plate. A patient's expectations will, as is often the case, need to be tempered and realistic. Clearanail cannot be more than what it is. 

The grossly infected nail will likely require from a patient many weeks or months of ongoing treatment. A treatment can be compromised when it is dependent on daily patient administered treatments. Contrary to claims, there is no strong published evidence yet, but this deficit can be corrected in time. The drill can certainly provide a Podiatrist with a very useful addition to the tool-box.

Congratulation to Dr. Rolf, who certainly deserves recognition for his innovative design. I will be inclined to be more generous, in my praise, if he addresses the nonsense restrictions, clearly designed to keep on ringing the suppliers cash-register. 

Is Clearanail the much awaited 'silver bullet'? This is certainly a welcome and useful bullet. But this is a bullet that is made of more base material - somewhere between silver and bronze.

 

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  • Comments (68)
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  • Dieter
    I agree with your cure definition In podiatry school it was drilled into my head to never use the word cure it meant I was getting rid of problem for ever
    I still recall one of my teachers calling me out for using the term cure and onychomyosis strange whatvexperiences in school have an effected on your thinking

    Biofilm I believe it might how a role in the treatment of onychomyosis and treatment still researching david
  •  The drilling industry is very new  and  there are  two more devices  that are in development as we speak.   I am very excited  about this  new  technology.   I dont want to give the  impression  that   this is 100% cure rate  Cure  rate is a term that not in my speech... but  this could contribute and maybe chnage  the standards of how we treat  Fungus Toe Nail.infections. Another  area that I find very exciting is  Biofilm.  If any one has experience with Biofilm and the treatment of  Fungus Toe Nails I would love to hear about this. Thanks.  David


    David,

    I don't have a problem with the term 'cure'. A 'cure' simply means the relief of symptoms of a disease or a condition. No more, no less.

    About biofilm ... I have no contribution in respect to linkage with OM. In regard to wound healing, some people make a lot of biofilm, while other wound experts now state this is over-played. What is your understanding of biofilm in the management of the fungal nail infection?

  • Quote:

    Any studies on using Clearanail vs Urea 40% combined with antifungal cream or solution? 


    Dan,

    The first question to ask is this: are there any studies that have looked at the outcome of Urea / antifungal combination therapy.

    You know, already, there are no studies to compare Urea vs Clearanail. It is perfectly ok to consider alternative treatment techniques for OM when there are no resources to invest in contemporary technology to provide an additional treatment option for a patient. Nothing wrong with that, at all.

    Not every patient will want, or need, complete urea induced debridement of a nail. I have also used this approach in the past, when a patient consents to do so, and when there is a grossly infected nail covering most, if not all, of the nail plate.

  • Any studies on using Clearanail vs Urea 40% combined with antifungal cream or solution? 

  • Quote:

     Dieter

     

     I agree with your comment about  penetration and dispersment of the Topical Anti-fungal...  Another possible reason might be  there is more pain and potential trauma to the  nail plate and  or bed.  which may lead to damage to the nail bed.with a larger drill diameter.    I believe that was  one of Dr. Thomas  comments when I spoke with him months ago regarding this topic of  drill dm.  but  I am not 100% sure. Next time I speak with him  I will re-visit  the reasoning  he had.   The cleananail can  handle  0.6mm SUM  as well as 0.4mm.  

     The drilling industry is very new  and  there are  two more devices  that are in development as we speak.   I am very excited  about this  new  technology.   I dont want to give the  impression  that   this is 100% cure rate  Cure  rate is a term that not in my speech... but  this could contribute and maybe chnage  the standards of how we treat  Fungus Toe Nail.infections. Another  area that I find very exciting is  Biofilm.  If any one has experience with Biofilm and the treatment of  Fungus Toe Nails I would love to hear about this. Thanks.  David

    David,

    No nail bed trauma or bleeding was observed in the Gupta study.

  •  Dieter

     

     I agree with your comment about  penetration and dispersment of the Topical Anti-fungal...  Another possible reason might be  there is more pain and potential trauma to the  nail plate and  or bed.  which may lead to damage to the nail bed.with a larger drill diameter.    I believe that was  one of Dr. Thomas  comments when I spoke with him months ago regarding this topic of  drill dm.  but  I am not 100% sure. Next time I speak with him  I will re-visit  the reasoning  he had.   The cleananail can  handle  0.6mm SUM  as well as 0.4mm.  

     The drilling industry is very new  and  there are  two more devices  that are in development as we speak.   I am very excited  about this  new  technology.   I dont want to give the  impression  that   this is 100% cure rate  Cure  rate is a term that not in my speech... but  this could contribute and maybe chnage  the standards of how we treat  Fungus Toe Nail.infections. Another  area that I find very exciting is  Biofilm.  If any one has experience with Biofilm and the treatment of  Fungus Toe Nails I would love to hear about this. Thanks.  David

  • Quote:

    Dieter -what makes a micropore better than the larger pore mentioned in the study? Is the intelligence of the clearanail the price being asked here in America or in the fact the micropore is better that a "standard" hole.

    Jeff,

    I didn't say it was better. The definitive answer would be the subject of yet another study. Until I read the paper I was unaware there is competing technology to Clearanail. The nail drill used in this study also has a built-in intelligent safety design operating on the principle of humidity level detection, to determine when to stop. I don't know the cost of the equipment.

    But since the question is asked: I don't know that we can say for certain there is a clinical advantage to having a 0.4mm v. 1.8mm drill hole. However, if you take a look at the clinical pictures, from this study you can appreciate that even a single 1.8mm is pretty darn big! Fewer holes are then applied. There are very many 0.4mm micro-holes produced with the micropore Clearanail technique. This is certainly better from a cosmetic point of view. In addition I can only speculate that, perhaps, the greater pore number might disperse the anti-fungal solution more evenly and over a wider area.  



  • Quote:

    Dieter -what makes a micropore better than the larger pore mentioned in the study? Is the intelligence of the clearanail the price being asked here in America or in the fact the micropore is better that a "standard" hole.

    Capillary action.

     

    Think of a fine pipette vs one with a bigger bore in chemistry.

    Dennis

     

  • Quote:

    Dennis, 

    Your statement that "Custom foot orthotics, according to the literature, do not reduce injury risk in or treat soft tissue injuries long term," is incorrect.   

    http://www.cochrane.org/CD006801/MUSKEL_custom-made-foot-orthoses-for-the-treatment-of-foot-pain_

    Eric

    Eric

    I stand by my statement.

    Dennis

  • Dieter -what makes a micropore better than the larger pore mentioned in the study?
    Is the intelligence of the clearanail the price being asked here in America or in the fact the micropore is better that a "standard" hole.
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