Fractional CO ₂ laser plus topical antifungal versus fractional CO ₂ laser versus topical antifungal in the treatment of onychomycosis

Abstract

Onychomycosis is an important medical disorder affecting both health and quality of life of patients. This study was done to compare the efficacy of CO 2 laser in combination with topical tioconazole versus CO 2 laser only versus topical tioconazole alone in onychomycosis. A total of 120 patients with onychomycosis were randomly assigned to three groups. Group A patients were treated with fractional CO 2 laser followed by topical tioconazole 28% for five sessions with 3 weeks interval. Group B patients were treated with only fractional CO 2 laser for five sessions with 3 weeks interval. Group C patients were treated with only topical tioconazole 28% for 16 weeks. The clinical effect, KOH examination, and culture for the affected nails in the three groups were analyzed.One month after the last session, regarding clinical response, 55% showed complete clinical improvement in Group A versus 30% in Group B versus 25% in Group C with a significant difference in between. There was a significant difference between the three studied groups as regard KOH test and culture after treatment. Fractional CO 2 laser combined with topical antifungal is a safe and effective treatment for onychomycosis. K E Y W O R D Sfractional CO 2 laser, onychomycosis, tioconazole

Combination Therapy Should Be Reserved as Second-Line Treatment of Onychomycosis: A Systematic Review of Onychomycosis Clinical Trials

“…Laser and topical efinaconazole combination resulted in significantly greater improvement in the Scoring Clinical Index for Onychomycosis (SCIO) index at 36, 48 (both p = 0.04), and 52 weeks ( p = 0.02) compared to topical efinaconazole monotherapy, with no significant difference in mycological cure rates [ 36 ]. Laser and topical tioconazole had significantly higher clinical cure, patient satisfaction, negative potassium hydroxide, and negative fungal culture (55%, 60%, 80%, 70%, respectively) rates than laser (30%, 40%, 55%, 30%, respectively) or topical tioconazole (25%, 30%, 55%, 30%, respectively) monotherapies ( p < 0.05, all) [ 39 ]. Laser and topical luliconazole resulted in significantly greater mycological cure rates 3 months after the last treatment (69.6% vs. 57.4%; p = 0.006) and clinical cure rates at 3 (69.6% vs. 50.9%; p = 0.004) and 6 months (73.0% vs. 52.8%; p = 0.002) than laser monotherapy [ 40 ].…”

Efficacy and safety of CO2 laser in the treatment of chronic wounds: A Retrospective Matched Cohort Trial

“…Efficacy of CO 2 laser has been reported in a variety of dermatologic conditions including acne scars, actinic keratoses, onychomycosis, and striae distensae. 16,[30][31][32] However, clinical research on CO 2 laser debridement used for chronic cutaneous wounds has been scant. The present study is the largest clinical study to date comparing CO 2 debridement with routine debridement for chronic cutaneous wounds.…”

“…Efficacy of CO 2 laser has been reported in a variety of dermatologic conditions including acne scars, actinic keratoses, onychomycosis, and striae distensae 16,30–32 . However, clinical research on CO 2 laser debridement used for chronic cutaneous wounds has been scant.…”

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

“…This combination has as a counterpart a greater sensation of pain. 24,25 The common protocol for onychomycosis treatment carried out in the studies published using MAL as PS consisted of 3 PDT sessions, separated by an interval of 1 or 2 weeks, using MAL 16%, 3 hours as incubation time and red light (λ = 630 nm, 37 J/cm 2 ). 15,26 In contrast, studies using MB consisted of 12 sessions with an interval of 15 days between them, 3 minutes as incubation time, and red light (λ = 630 nm, 36-18 J/cm 2 ) using MB (2%).…”

“…Recently, there are more and more studies which propose a previous pretreatment of the affected nail with fractionated CO 2 or Er:YAG lasers, enhancing the absorption of PS without the needed of the use of urea 40% and increasing the aesthetic outcome. This combination has as a counterpart a greater sensation of pain 24,25 …”