The future of lasers in onychomycosis

Gupta, Aditya K.; Simpson, Fiona; Df, Heller

doi:10.3109/09546634.2015.1066479

Cited by 24 publications

(19 citation statements)

References 24 publications

(17 reference statements)

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“…Ten more points were added if longitudinal lines or subungual hyperkeratoses were visible. The total score also led to three categories of onychomycosis severity: 'mild' (equating to a score of 1-5), 'moderate' (6)(7)(8)(9)(10)(11)(12)(13)(14)(15) and 'severe' (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35).…”

Section: Assessment Of Therapeutic Endpointsmentioning

confidence: 99%

Treating onychomycosis with the short‐pulsed 1064‐nm‐Nd:YAG laser: results of a prospective randomized controlled trial

Karsai

Jäger

Oesterhelt

et al. 2016

Acad Dermatol Venereol

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Section: Assessment Of Therapeutic Endpointsmentioning

confidence: 99%

Treating onychomycosis with the short‐pulsed 1064‐nm‐Nd:YAG laser: results of a prospective randomized controlled trial

Karsai

Jäger

Oesterhelt

et al. 2016

Acad Dermatol Venereol

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“…This can allow for the accumulation of heat inside the fungal cell and prevent severe pain/necrosis in surrounding tissues. To obtain consistent laser treatments, a spatially uniformed beam is recommended to prevent any ‘hot spots’ from occurring . The wavelength of a laser needs to selectively target the fungi and be able to penetrate the nail plate .…”

Section: Introductionmentioning

confidence: 99%

“…17,21,22 Thus, lasers should be delivered in pulse durations. 23,24 Pulse durations need to be shorter than the thermal relaxation time of the fungus in order to be effective. 23,24 This can allow for the accumulation of heat inside the fungal cell and prevent severe pain/necrosis in surrounding tissues.…”

Section: Introductionmentioning

confidence: 99%

“…23,24 Pulse durations need to be shorter than the thermal relaxation time of the fungus in order to be effective. 23,24 This can allow for the accumulation of heat inside the fungal cell and prevent severe pain/necrosis in surrounding tissues. To obtain consistent laser treatments, a spatially uniformed beam is recommended to prevent any 'hot spots' from occurring.…”

Section: Introductionmentioning

confidence: 99%

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A critical review of improvement rates for laser therapy used to treat toenail onychomycosis

Gupta

Versteeg

2017

Acad Dermatol Venereol

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Onychomycosis is a nail infection that is primary caused by dermatophytes. Alternative treatments are needed as current therapies (oral and topical antifungals) have limited effectiveness. Lasers are currently approved by the FDA to temporarily increase the amount of clear nail in onychomycosis patients. Lasers can theoretically elicit fungicidal effects but in practice produce mixed results. This review compared laser-induced improvement rates to FDA-approved indications and traditional onychomycosis treatments. A review of the literature (PubMed, Clinicaltrials.gov, Medline and Embase) was used to locate articles for this review. RCTs, non-randomized, uncontrolled and retrospective studies that included at least one of the following measures were eligible; complete cure, mycological cure, clinical improvement and clinical cure. Mycological cure (negative culture and negative microscopy) was evaluated in two studies using patients as the unit of analysis with an average rate of 11%, increasing to 63% when nails were used as the unit of analysis (three studies). Clinical cure (100% clear nail) was evaluated in six studies with a rate of 13% using nails as the unit of analysis and 13% when patients were used as the unit of analysis (two studies). Clinical improvement (at any time point) was found in 36% of patients (five studies) and 67% of nails (nine studies). Nail clarity as measured by clear nail growth and/or nail plate/bed clearance at 12 weeks was found to be 2.6 mm across onychomycotic nails. Laser studies, to date, provide preliminary evidence of clinical improvement and clear nail growth in toenail onychomycosis, consistent with the FDA clearance for aesthetic endpoints. Laser studies however do not provide efficacy rates for medical endpoints that equate or exceed those found with traditional therapies (oral and topical treatments).

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“…The number of professional lasers approved by the US Food and Drug Administration (FDA) for "temporary clearance" of onychomycosis is continually increasing, most of which are long-pulsed 1,064-nm neodymium:yttrium-aluminum-garnet lasers (LPNYLs) [8,9]. Some researchers believe that laser treatment of onychomycosis is safe and effective [10,11], while others have stated that the use of the Nd:YAG 1,064-nm laser is invalid for treating onychomycosis [12]. Studies to date have been small and contradictory, and there are few prospective, randomized controlled studies of laser therapy combined with or in comparison to conventional therapies.…”

Section: Patients Includedmentioning

confidence: 99%

The Energy Density and Treatment Times Are the Main Factors That Affect the Efficacy of Long-Pulsed 1,064-nm Nd:YAG Laser Treatment for Onychomycosis Caused by Trichophyton rubrum

Liu¹,

Zhang²,

Zeng³

et al. 2018

Dermatology

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Background: No optimal regimen exists for the LPNYL (long-pulsed 1,064-nm neodymium:yttrium-aluminum-garnet laser) for treating onychomycosis. Objective: To establish an optimal LPNYL treatment regimen for onychomycosis caused by Trichophyton rubrum (OCTr). Patients and Methods: First, 511 infected nails of 177 patients were treated using LPNYL with orthogonally designed regimens according to various energy densities, spot sizes, pulse widths, and treatment times. The optimal treatment regimen was established by multivariate analysis. Next, 69 patients with 221 infected nails were randomized to receive oral itraconazole (drug group) and the optimal regimen of LPNYL treatment (laser group). The clinical efficacy (CE) and mycological efficacy (ME) were evaluated at 6 and 12 months following the start of treatment, and adverse reactions were recorded in both groups. Results: Both CE and ME were significantly correlated with the energy density (p < 0.05) and treatment times (p < 0.05), but not with the spot size (0.071 0.05), and no significant difference was observed in CE at 12 months between the two groups (p > 0.05). At 6 months, the CE in the laser group was significantly higher than that in the drug group (p < 0.001). Conclusions: LPNYL is effective and safe for treating OCTr. The energy density and treatment times are the main factors that affect the efficacy. The optimal regimen for LPNYL is an energy density of 45 J/cm², pulse width of 35 ms, spot size of 4 mm, frequency of 1 Hz, and 6 treatments with 1-week intervals. Laser treatment has rapid clinical recovery.

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The future of lasers in onychomycosis

Abstract: There is substantial opportunity to improve the targeting and anti-targeting properties of lasers to address the specific considerations required to treat onychomycosis and, more generally, other dermal pathogens.

Cited by 24 publications

References 24 publications

Treating onychomycosis with the short‐pulsed 1064‐nm‐Nd:YAG laser: results of a prospective randomized controlled trial

Treating onychomycosis with the short‐pulsed 1064‐nm‐Nd:YAG laser: results of a prospective randomized controlled trial

A critical review of improvement rates for laser therapy used to treat toenail onychomycosis

The Energy Density and Treatment Times Are the Main Factors That Affect the Efficacy of Long-Pulsed 1,064-nm Nd:YAG Laser Treatment for Onychomycosis Caused by <b><i>Trichophyton rubrum</i></b>

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