Partial Necrosis of the Hallux in a Patient Treated With Laser for Onychomycosis

Leverone, Andréia Pizarro; Guimarães, Dávson Aguilar; Bernardes-Engemann, Andréa Reis; Orofino-Costa, Rosane

doi:10.1097/dss.0000000000000383

Cited by 5 publications

(2 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While this effect could also be attributed to the sole continuation of pharmacologic measures, the timely correlation to the start of laser therapy suggests that mycological cure in these cases is indeed rather the result of combination therapy. Adverse effects of laser therapy for onychomycosis reported in the literature range from pain up to tissue necrosis [ 24 , 43 ]. However, if performed responsibly it can be considered as safe and effective, as highlighted by our experience presented here.…”

Section: Discussionmentioning

confidence: 99%

Treatment of onychomycosis using a 1064-nm diode laser with or without topical antifungal therapy: a single-center, retrospective analysis in 56 patients

et al. 2018

View full text Add to dashboard Cite

BackgroundCurrently available treatment options for onychomycosis such as topical and systemic antifungals are often of limited efficacy, difficult to administer or associated with relevant side effects. Non-ablative laser therapy is proposed to represent a safe alternative without the disadvantages of drugs. Yet, to date, the efficacy of laser therapy for onychomycosis is discussed controversially. Against this background, we performed a systematic retrospective analysis of our clinical experience of 4 years of onychomycosis treatment applying a long-pulsed 1.064-nm diode laser.MethodsWe retrospectively evaluated the records of 56 patients with microscopic and culturally proven onychomycosis affecting a toenail of the hallux and other toes, who had been treated with a long-pulsed 1.064-nm diode laser (FOX, A.C.R. Laser GmbH, Nuremberg) during the time period of July 2013–December 2016 with or without concomitant topical antifungals. Thereof, 27 patients received laser treatment and 29 patients received laser treatment in combination with local antifungals. We conducted a mean of 3.9 laser treatments at 2–6-week intervals. The primary endpoint of our analysis was clinical improvement; secondary endpoints were complete remission of fungal pathogens in fungal culture and in microscopy.ResultsClinical improvement was achieved in 56% of patients treated with laser only after a mean of 4.5 treatments and in 69% of patients treated with laser in combination with topical antifungals after a mean of 3.6 treatments. Cultural healing was detected in 63% of patients treated with laser only after a mean of 5.4 treatments, vs. 86% of patients treated with laser and concomitant topical antifungals after a mean of 4.8 treatments. Microscopic healing (complete healing) with the absence of fungal pathogens was achieved in 11% of patients after a mean of 4.7 treatments with laser only, vs. 21% of patients treated with laser and concomitant topical antifungals after a mean of 4 treatments. No relevant adverse effects were observed.ConclusionsThe 1.064-nm diode laser is an effective and safe option for the treatment of onychomycosis. Of note, the combination with topical antifungals will increase overall treatment efficacy and reduce the time to healing. Particularly, patients with contraindications against systemic antifungals may benefit from this multimodal therapeutic approach. Our data, moreover, suggest that treatment efficacy is positively correlated with the total number of laser treatments.

show abstract

Section: Discussionmentioning

confidence: 99%

Treatment of onychomycosis using a 1064-nm diode laser with or without topical antifungal therapy: a single-center, retrospective analysis in 56 patients

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Recently, a case of partial necrosis of the hallux was reported in a patient with pigmented onychomycosis treated with 1,064-nm Q-switched Nd:YAG laser. The authors hypothesize that the nail pigment acted as a target for selective photothermolysis [9]. …”

Section: Answermentioning

confidence: 99%

Chromonychia in an Asymptomatic Vitamin Consumer

Fox

Baker

Tosti

2015

Skin Appendage Disord

View full text Add to dashboard Cite

Laser treatment of onychomycosis due to Neoscytalidium dimidiatum: An open prospective study

et al. 2017

View full text Add to dashboard Cite

Conventional systemic and topical treatments have proven ineffective for the treatment of onychomycosis caused by Neoscytalidium dimidiatum. Our aim was to evaluate the effectiveness and safety of laser monotherapy for the treatment of onychomycosis caused by this pathogen. Patients with clinical onychomycosis of the toenails and positive results both on direct mycological examination and N. dimidiatum culture underwent four 1064 nm Nd:YAG laser sessions with 6-week intervals between sessions. Participants were monitored by clinical examination supported by dermoscopy, measurement of diseased nail and the onychomycosis severity index (OSI), and by mycological examination for 12 months after completion of treatment. Treatment outcome was based on clinical and laboratory criteria and was divided in complete or partial cure, clinical improvement, treatment failure and relapse. No patient had complete or partial cure at any time during the study. Clinical improvement was observed in 40.6% of the patients at the end of the laser sessions; however, it did not persist during the follow-up. Treatment failure was observed in 64.7% of the patients at the end of 12 month follow-up period. Direct microscopy and culture results remained positive in most patients. Adverse events, in addition to treatment-related pain, were observed and considered severe in one case. The 1064 nm Nd:YAG laser was not able to cure onychomycosis caused by N. dimidiatum but temporarily improved the clinical appearance of the nail; however, adverse events may occur.

show abstract

Partial Necrosis of the Hallux in a Patient Treated With Laser for Onychomycosis

Cited by 5 publications

References 3 publications

Treatment of onychomycosis using a 1064-nm diode laser with or without topical antifungal therapy: a single-center, retrospective analysis in 56 patients

Treatment of onychomycosis using a 1064-nm diode laser with or without topical antifungal therapy: a single-center, retrospective analysis in 56 patients

Chromonychia in an Asymptomatic Vitamin Consumer

Laser treatment of onychomycosis due to Neoscytalidium dimidiatum: An open prospective study

Contact Info

Product

Resources

About