The Effect of Long-Pulsed Nd:YAG Laser for the Treatment of Onychomycosis

Okan, Gökhan; Tarıkçı, Nagehan; Gökdemir, Gonca

doi:10.7547/15-137

Cited by 11 publications

(6 citation statements)

References 25 publications

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“…Moreover, similar results demonstrating the safety and effectiveness of the 1,064 nm Nd:YAG LASER in the treatment of onychomycosis have been previously shown 23,24 . We believe these effects are due to the capacity of long pulses of this LASER to induce a localized increase in temperature and subsequent destruction of the fungi 25,26 . Other possible irradiation effects are growth inhibition 27 and impairment of the fungal ability to penetrate keratinocytes.…”

Section: Discussionsupporting

confidence: 68%

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Morphological and ultrastructural changes in fungal agents after LASER application

Fernandes,

Arruda,

Santana

et al. 2023

Int J Dermatology

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BackgroundOnychomycosis is a fungal nail infection of difficult treatment due to the fungal survival capacity and reduced number of effective therapies. The present study aimed to isolate fungal agents that cause onychomycosis in immunocompetent patients and evaluate how LASER treatments affect the growth and ultrastructure of isolates.MethodsIn total, 21 patients with positive direct microscopic examination (DME) for onychomycosis had nail samples collected for cultivation and phenotypic identification of microorganisms. From these patients, 12 underwent LASER treatment, divided in Group 1 (n = 5) treated with Nd: YAG 1,064 nm, and Group 2 (n = 7) treated with Nd: YAG 1,064 nm + Er: YAG 2,940 nm + topical isoconazole. Transmission Electron Microscopy (TEM) was performed to evaluate ultrastructural changes after treatment.ResultsDME, cultivation, and phenotypic identification showed that the most identified fungus was Trichophyton rubrum spp. After LASER therapy, sample cultivation showed alterations in the fungal morphology with reduction of hyphae, conidia, and reproductive structures. Alterations in fungal cell wall structure, cytoplasm density, and organelles were observed by TEM.ConclusionLASER irradiation causes changes in the fungal cells, especially in the number of hyphae and the presence of conidia. In addition, it affects fungal growth and reproduction capacity, which interferes with their infection ability and virulence.

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Section: Discussionsupporting

confidence: 68%

“…23,24 We believe these effects are due to the capacity of long pulses of this LASER to induce a localized increase in temperature and subsequent destruction of the fungi. 25,26 Other possible irradiation effects are growth inhibition 27 and impairment of the fungal ability to penetrate keratinocytes.…”

Section: Discussionmentioning

confidence: 99%

Morphological and ultrastructural changes in fungal agents after LASER application

Fernandes,

Arruda,

Santana

et al. 2023

Int J Dermatology

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“…For five of the six patients with mycological or clinical cure, this was the first line of treatment. Median baseline SCIO was slightly lower in the responders (20 [11.7-24.8]) as compared to the non-responders (30 [20][21][22][23][24][25][26][27][28][29][30]) group. Among the patients with baseline SCIO ≤ 20, 42.9% were responders, while only 24% of the patients with baseline SCIO > 20 were responders (OR: 0.9 [0.13-6.52]) (Figure 2).…”

Section: Re Sultsmentioning

confidence: 99%

“…Okan et al measured 60% mycological cure and 47% clinical improvement rates in mycotic nails subjected to spiral long-pulsed Nd:YAG laser illumination. 26 Over 70% of the nails were infected with Trichophyton sp., but no subspecies details were provided. In addition, the patient age and medical profiles were not detailed.…”

Section: 8% Of a 72-patient Cohort Within 3 Months Of A Four-sessionmentioning

confidence: 99%

Nd:YAG 1064 nm laser treatment for onychomycosis ‐ is it really effective? A prospective assessment for efficiency and factors contributing to response

Ramzy,

Emily,

Jiryis

et al. 2023

Mycoses

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Onychomycosis is a highly prevalent and persistent nail disorder primarily caused by dermatophytes. The effectiveness of current topical and systemic antifungals is limited by the extent and severity of the infection, patient demographics and health status, hepatic toxicity, drug interactions and low compliance. Laser therapy is a promising modality for safe and cost‐effective removal of mycotic nail. This prospective study assessed the performance of a multi‐series long‐pulsed Nd:YAG 1064 nm regimen (30–40 J/cm2, 1 Hz) in the treatment of 213 mycotic nails in 31 patients. Pain and discomfort were scored at each treatment session and mycological and clinical cure rates were determined 3 months after the last treatment session. Patients presented with mostly severe (mean SCIO score: 21.9 ± 8.9), T. rubrum‐positive (87.1%) infections. Most (61%) had a family history of onychomycosis and a significant proportion had comorbidities, including hypertension (38.7%), hyperlipidemia (35.5%) and/or diabetes (12.9%). Treatment was well tolerated and there were no reports of nail deformity or burns. By 3 months post‐treatment, mycological cure was achieved by 4 (12.9%) and visual improvements were noted for 10 (32.3%) patients, including 3 (9.7%) with moderate to significant improvements. Clinical response correlated with baseline SCIO ≤ 20 (OR: 0.9 [0.13–6.52]), family history of onychomycosis (OR: 0.27 [0.04–1.50]) and comorbidities (OR: 0.44 [0.05–3.74]). In conclusion, Nd:YAG 1064 nm laser is safe and effective for the management of mild‐to‐moderate onychomycosis in diverse populations. Further studies will be necessary to adjust treatment parameters to patient and nail profiles and to determine the impact of combined laser and topical therapies.

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“…Of the 302 PubMed initial search results, 182 clinical trials (28,352 participants) met inclusion criteria and were included in the final analysis 6–186 . The PRISMA study selection process is detailed in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

Race reporting and representation in onychomycosis clinical trials: A systematic review

Chang

Qiu

Lipner

2021

Mycoses

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Onychomycosis is the most common nail disorder seen in clinical practice with a prevalence of 8.7%-13.8% in the United States (US). [1][2][3] There has been a trend towards increased racial and ethnic diversity in the United States, with current projections estimating that minority representation will exceed 50% of the population by 2044. 4 Demographic reporting and inclusion of diverse populations within clinical trials is critical to interpret treatment efficacy and prognosis for different groups. A systematic review on racial/ ethnic reporting of dermatology clinical trial participants has been performed, 5 but similar data from onychomycosis clinic trials have not been studied. Our objectives were to systematically review racial/ethnic reporting and representation, as well as, outcomes by race/ethnicity in onychomycosis clinical trials. | MATERIAL S AND ME THODSPubMed was searched in August 2020 for all peer-reviewed, Englishlanguage onychomycosis clinical trials. The keyword 'onychomycosis' was searched with no date ranges, article type filtered for 'Clinical

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The Effect of Long-Pulsed Nd:YAG Laser for the Treatment of Onychomycosis

Abstract: Based on these results, long-pulsed Nd:YAG laser can be used as an effective treatment for onychomycosis, but further studies are needed to draw firmer conclusions.

Cited by 11 publications

References 25 publications

Morphological and ultrastructural changes in fungal agents after LASER application

Morphological and ultrastructural changes in fungal agents after LASER application

Nd:YAG 1064 nm laser treatment for onychomycosis ‐ is it really effective? A prospective assessment for efficiency and factors contributing to response

Race reporting and representation in onychomycosis clinical trials: A systematic review

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