Journal of Clinical and Aesthetic Dermatology

AUG 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

Issue link: http://jcadonline.epubxp.com/i/870497

Contents of this Issue

Navigation

Page 55 of 67

56 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY august 2017 • Volume 10 • number 8 O O nychomycosis is an infection of the nail plate by fungal microorganisms. this infection has an important social impact on women and men and poses a major challenge for its treatment. the traditional treatment of onychomycosis involves the use of topical and oral antifungal agents. however, the presence of adverse effects frequently associated with oral antifungals, their high cost, and their potential interactions with other drugs reflect some of the problems associated with conventional therapy. the current report details the evaluation of a 1340nm laser as monotherapy for toenails affected by onychomycosis. a 1340nm, neodymium- yttrium:yttrium-aluminum-perovskite (nd:yaP) (e) laser (etherea, industra technologies, Brazil) was used with the following treatment parameters: a spot size of 6mm, pulse duration of 5ms, fluence of 22 to 25J/cm², and repetition rate of 1.5 to 2.5hz. in all, 72 toenails were evaluated in 30 patients who had clinical and laboratory confirmation of onychomycosis. the efficacy of treatment was measured by the degree of patient satisfaction on a scale of 0 to 10 and by mycological cure evidenced by direct mycological exam and culture. considering three applications of laser therapy and a clinical/laboratory follow-up period of 12 weeks, monotherapy with 1340nm laser was not effective, since 93.3 percent of the assessed patients remained without clinical and mycological cure. Despite reports of variable success rates with the use of different lasers for the treatment of onychomycosis, it is not yet possible to state that this therapeutic alternative is indicated for the treatment of these infections, mainly due to the limited number of patients and/or nail plates evaluated and the controversial results described in the literature. KEY WORDS: Onychomycosis, toenails, 1340nm nd:yaP laser, monotherapy a B s t r a c t O r i g i n a l r e s e a r c h 1340nm LASER THERAPY FOR ONYCHOMYCOSIS: negative results of Prospective treatment of 72 toenails and a literature review by GRACIELA ARAÚJO DO ESPÍRITO-SANTO; DINIZ PEREIRA LEITE JR; HUGO DIAS HOFFMANN-SANTOS; LUCIANA BASILI DIAS; and ROSANE CHRISTINE HAHN Drs. espírito-santo, leite, hoffmann-santos, Dias, and hahn are with the faculty of medicine, Post graduate in health sciences at the federal university of mato grosso, cuiabá, mato grosso, Brazil. Drs. leite and hahn are with specialized medical mycology center, federal university of mato grosso, cuiabá, mato grosso, Brazil. Drs. leite and hoffmann-santos are with university center of Varzea grande, Várzea grande, mato grosso, Brazil. J Clin Aesthet Dermatol. 2017;10(8):56–61 FUNDING: financial support for this study was provided by faPemat – fundação de amparo à Pesquisa no estado de mato grosso (foundation for the support of science of the state of mato grosso). DISCLOSURES: the authors have no conflicts of interest relevant to the content of this article. AUTHOR CORRESPONDENCE: rosane christine hahn, rchahn@terra.com.br OnychOmycOses are fungal infectiOns that are extremely prevalent in the world population and may reach infection rates of up to 24 percent in the elderly. 1 Due to the high adaptation of fungal microorganisms to keratinized nail tissue, the persistence of fungal spores in nail tissues leads to frequent recurrences. 2 unfortunately, the application of topical drugs is not effective, and the use of oral antifungals presents a series of undesirable adverse effects, in addition to their high cost. 3 for these reasons, laser therapy, a novel, alternative option, might be considered, especially for pregnant patients and patients with pre-existing diseases. in 2010, the united states food and Drug administration (fDa) approved different laser systems for clearing the nail plate. 4 it is important to emphasize that as a criterion for the cure of onychomycosis, mycological exam results should be negative after the laser sessions and at the time of clinical and laboratory follow-up. therefore, the clinical improvement or clearing of the nail plate alone would not be satisfactory to define the cure of the clinical presentations previously diagnosed as onychomycosis. however, due to the minimal invasive nature of the procedure, the low number of sessions recommended for treatment, and the possibility of clearing the nail plate, the use of laser therapy currently has been considered an alternative for the treatment of onychomycosis, at the expense of conventional treatment based on antifungal drugs. this study evaluated the efficacy of 1340nm neodymium-yttrium:yttrium-aluminum-perovskite (nd:yaP) laser therapy performed in three sessions at three-week intervals for treating onychomycosis, as

Articles in this issue

Links on this page

Archives of this issue

view archives of Journal of Clinical and Aesthetic Dermatology - AUG 2017