Lasers to treat nail fungal infections (Onychomycosis)

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

Lim EH, Kim HR, Park YO, Lee Y, Seo YJ, Kim CD, Lee JH, Im M.

J Am Acad Dermatol. 2014 May;70(5):918-23. doi: 10.1016/j.jaad.2014.01.893. Epub 2014 Mar 18.

• Nail onychomycosis is a infectioyus fungal infection which typically affects the toenails. Although present in young people where treatment can be straightforward with oral antifungals, treatment such as terbinafine are often difficult to use in individuals with liver dysfunction and a blood test should be edone in individuals over 50.
• Also multiple medications in the elderly can interfere with other drugs metabolized in the liver. In those cases, topical treatments (amorolfine, ciclopiroxilamine…) are used although the treatment which is long in the first space is also notoriously ineffective.

• The authors evaluated the combination of a topical antifungal therapy with a fractional carbon-dioxide laser.
• 24 patients were treated for 12 weeks (3 sessions with 4-week intervals) and the following evaluation methods were recorded: standardized photographs, a microscopic examination of subungual debris, and subjective evaluations.
• Results show that 92% showed a clinical response and 50% showed a complete response with a negative microscopic result. A thicker nail implied a poorer response. The treatment was well tolerated and there was no recurrence 3 months after the last treatment.

Comment: Although the study is limited in the number of patients as well as the lack of a control group, the treatment combining fractional-CO2 Laser and topical antifungals remains an option when oral antifungals are contraindicated

Contributors

Dr Christophe Hsu – dermatologist. Geneva, Switzerland