Laser Therapy for Onychomycosis

Abstract

Background: Laser therapy is a rapidly expanding new treatment modality for onychomycosis.Objective: To review current and prospective laser systems for the treatment of onychomycosis.Method: We searched the PubMed database, the Food and Drug Administration 510(k) database, ClinicalTrials.gov, and Google Scholar for in vitro studies, peer-reviewed clinical trials, manufacturers' white papers, and registered clinical trials of laser systems indicated for the treatment of onychomycosis. All published clinical trials were assessed on a 20-point methodological quality scale.Results: We identified three basic science articles, five peer-reviewed articles, three white papers, and four pending clinical trials, as well as numerous gray literature documents. The overall methodological score for the clinical trials was 9.1 6 1.1, with peerreviewed studies showing a higher score (9.8 6 1.5) than white papers (7.5 6 0.7). We also identified 11 commercial laser device systems of varying global availability. Conclusion: Laser therapy has been tested and approved as a cosmetic treatment only for onychomycosis. It cannot be recommended as a therapeutic intervention to eradicate fungal infection at this time as more rigorous randomized, controlled trials are required to determine if laser therapy is efficacious on par with oral and topical interventions.Contexte: Le traitement au laser gagne rapidement du terrain comme nouvelle forme de traitement de l'onychomycose.Objectif: L'é tude visait à passer en revue les dispositifs laser actuels et futurs dans le traitement de l'onychomycose.Mé thode: Nous avons procé dé à une recherche documentaire dans les bases de donné es PubMed, ClinicalTrials.gov, et Google Scholar ainsi que dans la base de donné es 510(k) de la Food and Drug Administration à la recherche d'é tudes in vitro, d'essais cliniques jugé s par les pairs, de documents produits par les fabricants et d'essais cliniques inscrits, portant sur diffé rents dispositifs laser indiqué s dans le traitement de l'onychomycose. Tous les essais cliniques publié s ont é té soumis à une é valuation de la qualité mé thodologique sur une é chelle de 20 points.Ré sultats: La recherche a permis de recenser trois articles en science fondamentale, cinq articles jugé s par les pairs, trois documents produits par les fabricants, et quatre essais cliniques en cours, ainsi que de nombreux é crits tiré s de la documentation parallè le. La note globale de l'é valuation mé thodologique des essais cliniques s'é levait à 9.1 6 1.1; les é tudes jugé es par les pairs avaient un ré sultat plus é levé (9.8 6 1.5) que les documents produits par les fabricants (7.5 6 0.7). Onze dispositifs au laser utilisé s à des fins commerciales, d'une disponibilité gé né rale variable, ont aussi é té relevé s dans la documentation.Conclusion: Le traitement au laser n'a é té vé rifié et approuvé aux fins de traitement esthé tique que dans l'onychomycose. Il ne peut ê tre recommandé à l'heure actuelle comme intervention thé rapeutique pour supprimer une infection fongique,...

Fungal Nail Infections (Onychomycosis): A Never-Ending Story?

“…Laser treatment has been approved for cosmetic treatment only, but efficacy as a treatment to eradicate the fungal infection will have to be determined by additional randomized controlled trials [25]. There have been rare reports of onychomycosis cures following the use of phototherapy, which involves the irradiation of accumulated protoporphyrin within the fungal hyphae, leading to subsequent hyphal cell damage [26].…”

Antifungal therapy for onychomycosis in children

“…One such modality is laser therapy, which has been tested and approved as a cosmetic treatment for onychomycosis (64). Its fungicidal action occurs through a direct thermal effect and possibly via the generation of reactive oxygen species (65); however, there are no rigorous, randomized controlled trials testing it against current topical and oral therapies, making it difficult to evaluate its efficacy (64). Photodynamic therapy, ultrasound, and iontophoresis are also currently being explored as treatment modalities for onychomycosis but are only in the early stages of development (66).…”

Perspectivas de futuro en láseres, nuevas tecnologías y nanotecnología en dermatología

“…Sin embargo, no se pueden extrapolar las conclusiones de este ensayo in vitro a las condiciones de la práctica clínica. Se han utilizado láseres de Nd:Yag pulsados y Q-switched, así como láseres a 1.320, 870 y 930 nm en el tratamiento de la onicomicosis [37][38][39][40][41] . También existen estudios con terapia fotodinámica que han demostrado su utilidad incluso en casos de onicomicosis por hongos no dermatofitos, que suelen responder muy mal al tratamiento farmacológico clásico 42,43 .…”