Is there now a device that drills holes into the toenail so anti-fungals can be placed at the infection site?

I read about this in the Harvard Medical Newsletter.Is there now a device that drills holes into the toenail so anti-fungals can be placed at the infection site?
Well, a hot-ended paperclip is a device, so yes! :-)





From http://www.healthline.com/sw/hr-nl-toena鈥?/a> (skip first paragraph to get to the drilling part)...





Harvard researchers are testing two treatments that would take a more direct route to the fungi, yet would still manage to get into tissue that is, well, as tough as nails. One experimental treatment involves the use of short-wavelength light that's strong enough to shine through translucent nail tissue and disrupt the growth and reproduction of the light-averse fungi. The results, although preliminary, are promising, and patients feel only a slight sensation of warmth from the light, according to Dr. Alexa B. Kimball, the director of a skin disease clinical trial unit operated jointly by Massachusetts General Hospital and Brigham and Women's Hospital, both Harvard affiliates in Boston.





The other treatment involves cutting tiny holes in the nail. If you've ever banged the end of a finger or toe, you know how painful it can be when blood gathers under the nail and pushes on it. Doctors can treat these subungual (under the nail) hematomas by making holes in the nail so the blood can escape, relieving the pressure. Nail trephination, as it's called, for subungual hematomas has even been done with the hot end of a paper clip (but don't try this at home!).





Attacking toenail fungus this way involves rubbing antifungal cream into the holes so it reaches the fungi. Application of the cream isn't a problem 鈥?it can be done by patients at home, says Dr. Kimball. The tricky part is making the holes deep enough so the cream is effective, while not going too far and penetrating the nerve-laden soft tissue underneath. The Harvard researchers have used a new instrument with sensors that detect a change in resistance so it knows precisely how far to drill down. They hope to report results from the trial in 2007. In an earlier study, patients reported feeling virtually no pain when the same instrument was used to treat subungual hematomas.





Two important cautions: First, insurance companies tend to view toenail fungus as a cosmetic problem, so you may end up footing the bill for treatment, be it newfangled or an old standby. You may get coverage if you have diabetes, because toenail fungus in diabetics can lead to other sorts of infections. Second, people tend to assume that all deformed nails are caused by toenail fungus, when psoriasis, eczema, and other problems can affect nails. Be sure you have a definite diagnosis before starting any treatment.