A promising device-based therapy is laser treatment. The neodymium-doped yttrium aluminum garnet (Nd:YAG) device emits a laser in a continuous or pulsed fashion, and the 1064 nm wavelength is thought to be optimal due to its ability to penetrate deeply into the nail bed to eradicate fungal growth.28 Although this device is approved by the US Food and Drug Administration for use in patients with onychomycosis for a "temporary increase in clear nail,"28 there is a lack of research demonstrating effectiveness beyond several pilot studies. One study demonstrated mycologic cure in 7 out of 8 patients with no major side effects aside from temporary nail discoloration and occasional pin prick sensation.29 The parameters for the laser included a 0.65 ms pulse duration, 2 mm spot size and 223 J/cm2 energy fluence, and treatment consisted of 2 to 3 sessions spaced at least 3 weeks apart. A Chinese study of 33 patients demonstrated a 51% to 53% cure rate in patients treated for eight and four sessions respectively, spaced at 1 week intervals using a 30 ms pulse duration and 3 mm spot size laser at 240-324 J/cm2.30 Results from Japan showed a similar cure rate of 51% in 19 patients treated with 1 to 3 treatments 4 to 8 weeks apart.31 To our knowledge, no randomized control trials exist to validate these preliminary findings.