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Background: Onychomycosis is a chronic fungal nail infection caused predominantly by dermatophytes, and less commonly by non-dermatophyte molds (NDMs) and Candida species. Onychomycosis treatment includes oral and topical antifungals, the efficacy of which is evaluated through randomized, double-blinded, controlled trials (RCTs) for USA FDA approval. The primary efficacy measure is complete cure (complete mycological and clinical cure). The secondary measures are clinical cure (usually {less than or equal to}10 % involvement of target nail) and mycological cure (negative microscopy and culture). Some lasers are FDA-approved for the mild temporary increase in clear nail; however, some practitioners attempt to use lasers to treat and cure onychomycosis. Methods: A systematic review of the literature was performed in July 2020 to evaluate the efficacy rates demonstrated by RCTs of laser monotherapy for dermatophyte onychomycosis of the great toenail. Results: RCTs assessing the efficacy of laser monotherapy for dermatophyte toenail onychomycosis are limited. Many studies measured cure rates via nails instead of patients, and performed only microscopy or culture, not both. Only one included study reported mycological cure rate in patients as negative light microscopy and culture (0%). The combined clinical cure rates in short- and long-pulsed laser studies were (13.0-16.7% and 25.9%, respectively). There was no study that reported the complete cure rate, however, one did report treatment success (mycological cure (negative microscopy and culture) and {less than or equal to}10% clinical involvement) in nails as 16.7%. Conclusions: The effectiveness of lasers as a therapeutic intervention for dermatophyte toenail onychomycosis is limited based on complete, mycological, and clinical cure rates. However, it may be possible to use different treatment parameters or lasers with a different wavelength to increase the efficacy. Lasers could be a potential management option for older patients and onychomycosis patients with coexisting conditions such as diabetes, liver and/or kidney diseases for whom systemic antifungal agents are contraindicated or have failed.
Laser systems are a new treatment area for onychomycosis. As of January 2012, the US Food and Drug Administration (FDA) has approved four laser systems for the “temporary increase of clear nail in onychomycosis.” The FDA has approved these devices on the basis of “substantial equivalence” to predicate devices with similar technical specifications and applications. Laser therapy appears to be a promising alternative to traditional pharmacotherapy, but these systems have been tested in only limited clinical trials; therefore, it is not possible to compare their efficacy to the oral and topical drugs currently used in the treatment of onychomycosis. (J Am Podiatr Med Assoc 102 (5): 428-430, 2012)
Background: Onychomycosis is a chronic fungal nail infection caused predominantly by dermatophytes, and less commonly by nondermatophyte molds and Candida species. Onychomycosis treatment includes oral and topical antifungals, the efficacy of which is evaluated through randomized, double-blind, controlled trials for US Food and Drug Administration approval. The primary efficacy measure is complete cure (complete mycologic and clinical cure). The secondary measures are clinical cure (usually ≤10% involvement of target nail) and mycologic cure (negative microscopy and culture). Some lasers are US Food and Drug Administration approved for the mild temporary increase in clear nail; however, some practitioners attempt to use lasers to treat and cure onychomycosis.
Methods: A systematic review of the literature was performed in July of 2020 to evaluate the efficacy rates demonstrated by randomized controlled trials of laser monotherapy for dermatophyte onychomycosis of the great toenail.
Results: Randomized controlled trials assessing the efficacy of laser monotherapy for dermatophyte toenail onychomycosis are limited. Many studies measured cure rates by means of nails instead of patients, and performed only microscopy or culture, not both. Only one included study reported mycologic cure rate in patients as negative light microscopy and culture (0%). The combined clinical cure rates in short- and long-pulsed laser studies were 13.0%–16.7% and 25.9%, respectively. There was no study that reported the complete cure rate; however, one did report treatment success (mycologic cure [negative microscopy and culture] and ≤10% clinical involvement) in nails as 16.7%.
Conclusions: The effectiveness of lasers as a therapeutic intervention for dermatophyte toenail onychomycosis is limited based on complete, mycologic, and clinical cure rates. However, it may be possible to use different treatment parameters or lasers with a different wavelength to increase the efficacy. Lasers could be a potential management option for older patients and onychomycosis patients with coexisting conditions such as diabetes, liver, and/or kidney diseases for whom systemic antifungal agents are contraindicated or have failed.
Background:
Topical onychomycosis therapies are usually inadequate, and patient compliance to systemic therapies is poor. Recently, interest in laser therapy for the treatment of onychomycosis has increased. We sought to investigate the efficacy of long-pulsed Nd:YAG laser therapy for onychomycosis.
Methods:
Thirty patients with mycologically confirmed onychomycosis received long-pulsed 1064-nm Nd:YAG laser therapy, moving the beam in a spiral pattern over the whole nail plate two times, with a 1-minute pause between passes. Laser therapy was performed with a spot diameter of 4 mm at a speed of 25 mm/sec once weekly for 4 weeks using fluencies ranging from 40 to 60 J/cm2, depending on the thickness of the nail plate. Patients were evaluated in terms of clinical improvement and mycologic cure.
Results:
Thirty patients started and 15 completed the study. Mycologic cure was achieved in nine patients (60%), of whom eight (89%) were infected with Trichophyton sp. Complete clinical improvement was achieved in seven patients (47%), all of whom were infected with Trichophyton sp. Mycologic cure was not achieved in one of two patients infected with Epidermophyton or in either patient in whom the agent was Candida or Aspergillus; complete clinical improvement did not occur in any of these patients. No serious adverse events were observed.
Conclusions:
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.
We report on a patient with a large, painful hypertrophic scar on the plantar aspect of the left foot who was treated with carbon dioxide laser and a skin substitute (Apligraf) and followed up for longer than 1 year. To our knowledge, no other case reports have been published on the use of a skin substitute to gain coverage and resolution after excision of a hypertrophic scar by carbon dioxide laser. (J Am Podiatr Med Assoc 94(1): 61-64, 2004)
Background: Onychomycosis, or fungal nail infection, is the cause of 50% of onychopathies seen by podiatric physicians. This pathology is accompanied by a negative psychosocial component because of its effect on self-image, which is an essential part of social relations. Conventional pharmacologic treatment based on antifungal agents is lengthy and expensive and has a high abandonment rate and a low cure rate. Therefore, a faster and more efficient solution has been sought using laser treatment. However, studies on the efficacy of this physical method are not conclusive due to the lack of uniformity in the method used to apply the laser and an objective method to measure the results. The aim of this study was to measure the efficacy of laser treatment of onychomycosis by microbiological cure and clinical evolution using the Onychomycosis Severity Index.
Methods: A prospective study with a strictly repetitive protocol of Nd:YAG 1,064-nm laser was applied to 50 participants with onychomycosis in the first toe, following the manufacturer's instructions. The efficacy of the treatment on fungal infection was measured by microbiological culture before and after treatment. The clinical evolution of the nail dystrophy was quantitatively evaluated using the Onychomycosis Severity Index.
Results: The efficacy of Nd:YAG 1,064-nm laser in eliminating fungal infection was 30% (15 participants). However, significant improvement in nail appearance (dystrophy) was observed in 100% of patients (P < .001).
Conclusions: Laser treatment has relatively low efficacy in treating fungal infection but results in an objective improvement in the clinical appearance of the nail in 100% of patients.
Ablative fractional laser is suggested to promote wound healing in diabetic and venous leg ulcers. In this article, we report the treatment outcome of a recalcitrant foot ulceration related to lower leg arteriopathy. A 43-year-old man with typical digital substraction angiographic findings of arteriopathy was admitted to our department after 30 sessions of hyperbaric oxygen therapy. There was heterotopic tissue within the ulcer consistent with osseous metaplasia and mature bone tissue. This tissue was removed with full-field erbium:yttrium-aluminum-garnet laser, and the remaining parts received fractional erbium:yttrium-aluminum-garnet laser for the induction of wound healing. A decrease in ulcer dimensions was achieved by the second month of laser interventions without recurrence in the first-year control.
Many procedures have been described for the resection of plantar calcaneal spurs as treatment of heel spur syndrome and chronic plantar fasciitis. Most of these techniques involve a medial incision of between 2 and 6 cm for adequate exposure of the calcaneal spur. This article describes a new technique for resecting a calcaneal spur with a smaller medial incision using the holmium:yttrium-aluminum-garnet (Ho:YAG) laser. This laser permits adequate resection of a plantar calcaneal spur as well as coagulation of the bone and surrounding tissues. This minimally invasive procedure has been used with good results over the past year by the senior author (W.K.S.) for the resection of calcaneal spurs. (J Am Podiatr Med Assoc 91(3): 142-146, 2001)
Onychocryptosis is a common pathology treated by podiatry medical services, and in a considerable percentage, surgical procedures are required to achieve a solution. There are multiple surgical approaches for ingrown toenails, both incisional procedures and nonincisional procedures, such as chemical matrixectomies and physical matrixectomies using carbon dioxide laser. This study presents a surgical procedure for onychocryptosis using a physical matrixectomy with a 1064-nm laser applied by means of a 400-μm optical fiber and surgical removal of the posterior cauterized tissue to achieve healing by primary intention. This technique was performed on 30 patients with onychocryptosis affecting the great toe (Mozena stages I and IIa), and all of the patients were followed up postoperatively for 12 months. The patients reported minimal postoperative pain, quicker surgical postoperative healing, rapid return to activities of daily living, and minor postoperative recurrence compared with previous studies using incisional procedures and chemical matrixectomies.
Ingrown toenails are one of the most common pathologic conditions encountered in podiatric medical practice. Many methods of treatment for ingrown toenails have been used and studied, including chemical matrixectomies, surgical approaches, and CO2 laser ablation. This study is a retrospective review of a new technique that consists of resection of the involved nail matrix using a No. 15 blade and controlled cauterization using a CO2 laser. The technique was performed on 381 painful ingrown toenails, and all of the patients were followed up postoperatively for an average of 34 months. The results showed minimal pain, a low recurrence rate, rapid return to activity, and good cosmesis. (J Am Podiatr Med Assoc 95(2): 175–179, 2005)
