Fractional CO<sub>2</sub> laser in the management of onychomycosis

Arora, Sandeep; Lal, Sandeep; Janney, Manasa Shettisara; Ranjan, Eeshaan; Donaparthi, Navya; Dabas, Rajeshwari

doi:10.4103/jmms.jmms_53_19

Cited by 7 publications

(10 citation statements)

References 18 publications

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“…Bhatta et al 11 Lim et al 13 and Arora et al 14 also conducted a clinical trial using multiple sessions of fractional carbon dioxide laser along with a topical antifungal agent. Treatment of onychomycosis by urea occlusion prior to a single session of fractional carbon dioxide laser has also been reported.…”

Section: Discussionmentioning

confidence: 99%

“…9 More recent trials have explored fractional carbon dioxide lasers in combination with topical treatment and found it to be a viable option for management of onychomycosis. [10][11][12][13][14][15] In this context, we conducted a randomised controlled trial to compare the efficacy of a combination of fractional carbon dioxide laser with topical 1% terbinafine cream versus itraconazole in the management of onychomycosis and to find the possible superiority of one treatment over other.…”

Section: Introductionmentioning

confidence: 99%

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Fractional CO₂ laser with topical 1% terbinafine cream versus oral itraconazole in the management of onychomycosis: A randomized controlled trial

Ranjan¹,

Arora²,

Sharma

2022

IJDVL

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Background Onychomycosis accounts for 20-40% of all nail disorders. It is difficult to cure with resistance to anti-fungal drugs, their side effects and drug interactions limiting treatment options. Itraconazole is a widely accepted oral medication used for onychomycosis while fractional CO2 laser along with a topical anti-fungal has shown promising results for nail plate clearance in onychomycosis. Aim To compare the efficacy of fractional CO2 laser with 1% terbinafine cream versus itraconazole in the management of onychomycosis. Methods A prospective, randomised, single-centre, two-arm, parallel-group interventional study was conducted at Command Hospital Air Force, Bangalore. Onychomycosis cases confirmed by KOH mount/culture-positive were included. Patients were randomly divided into two groups. Group A received 4 sessions of fractional CO2 laser every fourth week with twice-daily application of 1% terbinafine cream; Group B received one-week pulse therapy with capsule itraconazole once every four-week for three pulses. The response was assessed by Onychomycosis Severity Index, a validated onychomycosis assessment scale, at baseline and at six months. Results Group A had 50 patients with a total of 98 nails. Clinical improvement was seen in 83/98 (84.7%) nails. The average reduction in Onychomycosis Severity Index was 8.65 (P < 0.05). Group B had 50 patients with a total of 136 nails. Clinical improvement was seen in 104/136 (76.5%) nails. The average reduction in Onychomycosis Severity Index was 7.37 (P < 0.05). Both groups showed statistically significant improvement measured by ‘Reduction in Onychomycosis Severity Index’ at six months; however, there was no significant difference between the two arms. Limitations The main limitations of the study are the small sample size and lack of long-term follow-up to assess recurrence of infection. Conclusion Fractional CO2 laser with 1% terbinafine cream is an effective and safe method for inducing nail clearance in onychomycosis and has efficacy similar to itraconazole pulse therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fractional CO₂ laser with topical 1% terbinafine cream versus oral itraconazole in the management of onychomycosis: A randomized controlled trial

Ranjan¹,

Arora²,

Sharma

2022

IJDVL

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“…Studies using fractional CO 2 laser have used fluence range of 10-150 mJ. [18,24,31] In a study by Hees et al, in a 9-month follow-up, the authors noticed that while there was 65% mycological clearance within the first 6 months, the effect slightly reversed at the end of 9 months. [13] In a study by Hollmig et al, at 12 months there was no significant difference in clearance between laser treated and control group.…”

Section: Onychomycosismentioning

confidence: 99%

“…After 4 monthly sessions, 88% nails showed culture clearance, and at 6-month follow-up, 88% of nails were culture-negative. [24] In a meta-analysis conducted by Ma et al in 2019, a total of 35 articles involving 1723 patients and 4278 infected nails were included. [25] The evaluation of the studies in this analysis revealed that the overall mycological cure rate was 63.0%.…”

Section: Onychomycosismentioning

confidence: 99%

Evolving role of lasers in nail therapeutics

Dhawan

Sharma²

2022

CSDM

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The diseases of nails are chronic disorders due to the slow rate of growth of nails. The slow rate of nail growth results in long treatment regimens, thus having the potential of causing side effects and posing a limitation of administration to many people. Patients who suffer from organ dysfunction, elderly patients, patients under polypharmacy, and the inability of many patients to adhere to the complete regimen can cause the treatment of nail diseases to be frustrating for both the treating dermatologists as well as patients. Most nail disorders have formed a set treatment protocol for the administration of oral and topical drugs over the years. The use of lasers has yet to make its mark in the treatment of nail diseases due to lack of a universally accepted protocol. This review article looks into various studies evaluating the efficacy of lasers in nail diseases. Largely, this review is based on an evaluation of the effectiveness of lasers in onychomycosis (22 studies and 1 meta-analysis) and nail psoriasis (seven studies). While there is sufficient proof that lasers are effective in the treatment of nails, there is no gold standard for the type of lasers to be used for a particular disease, the treatment parameters, and the follow-up protocol. Evaluation of larger sample sizes against a control group and longer follow-ups are the need of the hour for the formulation of much-needed protocols.

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“…Three passes were administered at the same site in static operating mode over the affected area including 1 mm normal appearing areas around them at interval of 4 weeks. [6] Outcome were assessed by using digital photography, KOH mounting, and the response was graded on basis of fully normal appearing nail, modified from Lim et al, [7] Whilst Topical antifungals alone are not effective, systemic antifungals are associated with increased incidence of adverse events. [8,9] Also the duration of treatment is prolonged, around 6-12 months for systemic and topical treatment with toe nails taking around 18 months to show remission.…”

Section: Procedures Of Fractional Co2 Lasermentioning

confidence: 99%

Study of Fractional Carbon Dioxide Laser in Treatment of Onychomycosis (100 Cases)

2022

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Background: Onychomycosis is a fungal infection of nail unit. Tinea unguium is dermatophytic nail infection. common dermatophytes causing onychomycosis is Trichophyton rubrum. Onychomycosis increase in frequency with age, amongst them adult males are more frequently affected than females. There are various topical and systemic antifungal agents available for onychomycosis. Despite this it is difficult to treat onychomycosis as higher local concentration of drug is required for clearing the infection and it is difficult to achieve. Aim and objectives: To ascertain efficacy of fractional carbon dioxide laser in onychomycosis. To evaluate fractional carbon dioxide laser's effectiveness in total clearance of onychomycosis from nails. Materials and methods: Methods: 100 patients of clinically diagnosed onychomycosis were selected. All patient’s KOH smear examination was done by collecting samples from scrapings of nail material. All patients were given systemic antifungals along with topical antifungals. Laser sittings had been done at an interval of 1 month. Total 6 monthly sittings were done. Topical lignocaine hydrochloride 2% w/v gel were applied for 20-30minutes before giving laser therapy. Standard digital photographs were taken before initiating the therapy and then repeated monthly. After completion of 6 months all patients were followed up for 9 months with an interval of 3 and 6 months. Results: At 6 months after completion of 6 sittings of CO2 laser 68 patients had complete response, 16 patients had significant response, 8 patients had moderate response, 8 patients had no response at 6 months of therapy. Limitations: Small population size, absence of control group, mycological culture was not performed were the main limitations of our study. Conclusion: Fractional carbon dioxide laser is effective in treating onychomycosis along with topical and systemic antifungals and it has minimal side effects. Keywords: Onychomycosis, fractional carbon dioxide (CO2) laser.

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Fractional CO₂ laser in the management of onychomycosis

Cited by 7 publications

References 18 publications

Fractional CO₂ laser with topical 1% terbinafine cream versus oral itraconazole in the management of onychomycosis: A randomized controlled trial

Fractional CO₂ laser with topical 1% terbinafine cream versus oral itraconazole in the management of onychomycosis: A randomized controlled trial

Evolving role of lasers in nail therapeutics

Study of Fractional Carbon Dioxide Laser in Treatment of Onychomycosis (100 Cases)

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Fractional CO2 laser in the management of onychomycosis

Cited by 7 publications

References 18 publications

Fractional CO2 laser with topical 1% terbinafine cream versus oral itraconazole in the management of onychomycosis: A randomized controlled trial

Fractional CO2 laser with topical 1% terbinafine cream versus oral itraconazole in the management of onychomycosis: A randomized controlled trial

Evolving role of lasers in nail therapeutics

Study of Fractional Carbon Dioxide Laser in Treatment of Onychomycosis (100 Cases)

Contact Info

Product

Resources

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Fractional CO₂ laser in the management of onychomycosis

Fractional CO₂ laser with topical 1% terbinafine cream versus oral itraconazole in the management of onychomycosis: A randomized controlled trial

Fractional CO₂ laser with topical 1% terbinafine cream versus oral itraconazole in the management of onychomycosis: A randomized controlled trial