Dermatologic surgery
Toenail onychomycosis treated with a fractional carbon-dioxide laser and topical antifungal cream

https://doi.org/10.1016/j.jaad.2014.01.893Get rights and content

Background

Traditional pharmacotherapy for onychomycosis has low to moderate efficacy and may be associated with adverse reactions and medication interactions limiting its use in many patients.

Objective

We evaluated the clinical efficacy and safety of a fractional carbon-dioxide laser with topical antifungal therapy in the treatment of onychomycosis.

Methods

In all, 24 patients were treated with fractional carbon-dioxide laser therapy and a topical antifungal cream. The laser treatment consisted of 3 sessions at 4-week intervals. Efficacy was assessed based on the response rate from standardized photographs, a microscopic examination of subungual debris, and subjective evaluations.

Results

Among the patients, 92% showed a clinical response and 50% showed a complete response with a negative microscopic result. The factors that influenced a successful outcome were the type of onychomycosis and the thickness of the nail plate before treatment. The treatment regimen was well tolerated and there was no recurrence 3 months after the last treatment episode.

Limitations

The study followed up only 24 patients and there were no relevant treatment controls.

Conclusions

Fractional carbon-dioxide laser therapy, combined with a topical antifungal agent, was effective in the treatment of onychomycosis. It should be considered an alternative therapeutic option in patients for whom systemic antifungal agents are contraindicated.

Section snippets

Patients

In all, 24 patients were enrolled in this prospective clinical trial. Participants were chosen from patients who had dystrophic nails that were clinically consistent with a fungal infection. To qualify for enrollment, subungual debris from the involved nail plate was obtained by using a small curette and then direct microscopy using 15% potassium hydroxide confirmed the fungal infection. All patients were not candidates for oral antifungal therapy because of drug interactions with other

Results

A total of 24 patients (16 female, 8 male) with an average age of 55.79 years (range, 29-68 years) were enrolled in this study. Although all patients had documented fungal infection based on potassium hydroxide examination of subungual debris at enrollment, 12 of these patients had samples submitted for fungal culture at enrollment. Cultures revealed 10 cases of Trichophyton rubrum, 1 case of Trichophyton mentagrophytes, and 1 case of Epidermophyton floccosum. The mean duration of the disease

Discussion

Onychomycosis is difficult to treat, and it has high rates of recurrence.1, 2 Treatment options for onychomycosis have historically included topical and oral antifungals.1 Topical therapies are limited by low efficacy because of subtherapeutic concentrations of antifungal medication reaching the nail bed.1, 2 Systemic antifungals are also limited in their use because of drug interactions and systemic adverse reactions.1, 2

In recent years, many laser systems have become available to physicians

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Supported by a grant from the Korea Ministry of Health and Welfare (A091121).

Conflicts of interest: None declared.

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