PHOTODYNAMIC ANTIMICROBIAL THERAPY (PACT) – A NEW APPROACH IN TREATMENT OF ONYCHOMYCOSIS (FUNGAL NAIL INFECTIONS)

Onychomycosis and its prevalence in Australia

Onychomycosis is a fungal infection of the nail and is estimated to affect up to 1.6 million Australians. Current treatments include antifungal nail lacquers that are applied daily/weekly and prescribed oral medications. Given the slow growth of toenails, it can be frustrating to continue applying the lacquers consistently as it takes at least 3 months to see improvements. In addition, oral medications can interact with other medications and can produce adverse effects making them unsuitable for some people.

What is PACT and how does it work?

Microorganisms including bacteria, viruses and fungi all possess a cell wall, whereas human cells typically only have a cell membrane. Upon application of the PACT Fungal Nail Gel, the dye selectively targets the fungal cell walls making them sensitive to light. The fungal cells can then be destroyed upon exposure to a specific wavelength, resulting in a chemical reaction that kills the targeted cells without harming healthy tissue.

Photodynamic therapy comprises three key components:

1. A Photosensitiser – non-toxic dye, Phenothiazine such as Toludine blue (tolonium chloride)
2. A light source – LED light
3. Tissue oxygen

When the photosensitiser, the PACT Fungal Nail Gel is exposed to a specific wavelength of light (630nM) delivered by the PACTMed LED, it becomes activated from a “ground” to an “excited” state. As it returns to the ground state, it releases energy, which is transferred to oxygen to reactive oxygen species (ROS), such as singlet oxygen and free radicals. These ROS mediate cellular toxicity and induce fungal cell death without affecting the surrounding tissue whose cells are impenetrable by the photosensitiser.

How long does a typical treatment take?

A typical treatment plan is:

• Nail preparation consisting of mechanical/chemical debridement of the affected nail(s)
• Application of the photosensitising gel
• Application of the light source
• Application of the light source
• Initial treatment regime includes 3 separate applications of PACT with the frequency determined by your podiatrist
• Review between 1-3 months after completion of treatment
• Periodic treatments to prevent re-infection as the nail grows

Tips to prevent re-infection

• Dry your feet thoroughly after showers
• Rotate shoes regularly to allow them to air and dry
• Wash hosiery in hot water and even apply an antifungal solution to the washing cycle
• Wear thongs in public showers and at swimming centres
• Wear socks that contain silver
• Don’t share nail clippers
• Minimise micro-trauma to the nails by ensuring correct shoe fitting

If you have any questions or concerns please feel free to visit us in clinic and we will happily answer your questions and discuss any concerns you have.

Have a great day and stay safe!

The team at Sole-Lution Podiatry