Efficiency of methylene blue‐mediated photodynamic therapy vs intense pulsed light in the treatment of onychomycosis in the toenails

Lam

et al. 2020

IAD

Background : Onychomycosis is a common fungal infection of the nail. Objective: The study aimed to provide an update on the evaluation, diagnosis, and treatment of onychomycosis. Methods: A PubMed search was completed in Clinical Queries using the key term “onychomycosis”. The search was conducted in May 2019. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews published within the past 20 years. The search was restricted to English literature. Patents were searched using the key term “onychomycosis” in www.freepatentsonline.com. Results : Onychomycosis is a fungal infection of the nail unit. Approximately 90% of toenail and 75% of fingernail onychomycosis are caused by dermatophytes, notably Trichophyton mentagrophytes and Trichophyton rubrum. Clinical manifestations include discoloration of the nail, subungual hyperkeratosis, onycholysis, and onychauxis. The diagnosis can be confirmed by direct microscopic examination with a potassium hydroxide wet-mount preparation, histopathologic examination of the trimmed affected nail plate with a periodic-acid-Schiff stain, fungal culture, or polymerase chain reaction assays. Laboratory confirmation of onychomycosis before beginning a treatment regimen should be considered. Currently, oral terbinafine is the treatment of choice, followed by oral itraconazole. In general, topical monotherapy can be considered for mild to moderate onychomycosis and is a therapeutic option when oral antifungal agents are contraindicated or cannot be tolerated. Recent patents related to the management of onychomycosis are also discussed. Conclusion: Oral antifungal therapies are effective, but significant adverse effects limit their use. Although topical antifungal therapies have minimal adverse events, they are less effective than oral antifungal therapies, due to poor nail penetration. Therefore, there is a need for exploring more effective and/or alternative treatment modalities for the treatment of onychomycosis which are safer and more effective.

Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Onychomycosis: An Updated Review

Lam

et al. 2020

IAD

“…A few clinical trials have been published on PDT, demonstrating that PDT could be a promising alternative to conventional antifungal therapy. 11,12 We conducted a short-and medium-term controlled trial to evaluate the effectiveness of PDT in the treatment of mild-to-moderate onychomycosis. In addition, a comparison between methylene blue (MB) and methyl aminolevulinate (MAL) as PSs was carried out in terms of clinical and mycological cure.…”

mentioning

confidence: 99%

“…IPL in the treatment of mild-moderate toenail onychomycosis, showing clinical improvement rates of 70% and 80%, respectively at 28 weeks from baseline 11. The fact that onychomycosis is usually not an immediate threat to their health may lead patients to delay treatment due to the high cost of antifungal medications and their potentially harmful side effects.…”

mentioning

confidence: 99%

Methylene blue vs methyl aminolevulinate photodynamic therapy in the treatment of mild‐to‐moderate toenail onychomycosis: Short‐ and medium‐term effects

Alberdi¹,

Gómez

2020

Dermatologic Therapy

Self Cite

Photodynamic therapy (PDT) has emerged as an interesting alternative option for onychomycosis treatment. The impact of a specific photosensitizer (PS) on the final result is an important factor to consider. We conducted a short-and medium-term controlled trial to compare the effectiveness of PDT in the treatment of mild-tomoderate onychomycosis when it is mediated by two different PSs. Twenty patients were randomized to receive nine sessions of PDT distributed over 16 weeks mediated either by methylene blue (MB/PDT group) or methyl aminolevulinate (MAL/ PDT group). Onychomycosis severity index (OSI) and nail involvement were checked along the study. Complete cure, treatment success, and clinical improvement were tabulated at 16 and 40-week follow-ups. OSI scores decreased significantly along the study, from 12.1 ± 5.4 to 3.6 ± 3.2 (MB/PDT group) and from 14.8 ± 6.0 to 5.4 ± 4.4 (MAL/PDT group). At 16-week follow-up, only 20% of the patients in the MB/PDT group reached complete cure and none in the group of MAL/PDT. At 40-week follow-up, complete cure rates were 70% and 40% in the MB/PDT group and MAL/PDT group respectively. Both modalities showed good outcomes in treatment of moderate toenail onychomycosis. MB/PDT showed a faster action but with relapse rates slightly higher than MAL/PDT.

“…Topical antifungal medications alone are a poor choice for ONM involving multiple toe nails owing to modest improvement and need for prolonged therapy. Physical therapies, especially photodynamic therapy (PDT) and laser treatment with long-pulsed Nd:YAG and/or fractional CO 2 lasers have recently been reported to provide good results in toe nail ONM when used in combination with topical and/or oral antifungals [2-4]. But high treatment cost, lack of adequate training of the healthcare provider, and patients’ reluctance for a “laser” treatment constitute important limitations of this approach.…”

Section: Introductionmentioning

confidence: 99%

Chemical Peeling as an Innovative Treatment Alternative to Oral Antifungals for Onychomycosis in Special Circumstances

Sonthalia¹,

Jakhar²,

Yadav³

et al. 2019

Skin Appendage Disord

Toe nail onychomycosis (ONM) is a common problem in elderly patients. Treatment in diabetic patients with associated comorbidities such as congestive heart failure becomes a challenge. Oral antifungals are best avoided owing to most of them being contraindicated or unsafe due to comorbidities and/or risk of drug interactions stemming from polypharmacy. Topical agents alone are not effective. Unlike isolated ONM in healthy and younger patients, ONM involving multiple nails in geriatric and diabetic patients warrants treatment as it serves as a source of recurrent tinea of the feet and other sites, and even contributes to formation of diabetic foot ulcers. Long-pulsed Nd:YAG and fractional CO₂ laser (in addition to antifungals) have been reported to provide gratifying results in toe nail ONM. But high treatment cost is a major limitation. Nail peeling with glycolic acid (GA) and low-concentration croton-oil free phenol (CFP) peels have been used in different nail conditions but not specifically for ONM. We report the successful use of Black peel (a superficial-to-medium depth peel used typically for anti-acne and cosmetic indications), a combination of 50% black acetic acid, 0.5% salicylic acid, 6% tetrahydrojasmonic acid, 10% bio sulphur, and 0.1% potassium iodide, in two difficult cases with ONM of multiple nails, the rationale of use being the additional anti-fungal effects of all the peel components.