34071 Combination of photodynamic therapy and oral antifungals for the treatment of onichomycosis

Abstract

Background: Onychomycosis (OM) represents 50% of nail pathology, making it one of the most prevalent fungal diseases and a therapeutic challenge. Photodynamic therapy (PDT) could be a therapeutic alternative due to its good adherence, low probability of resistance, no interaction with drugs, and acceptable risk-benefit. Patients and methods: Retrospective observational study that included all patients with a microbiological diagnosis of OM treated with PDT in our service (2013-2021). The protocol used was 16% methyl-aminolevulinate (MAL) as a photosensitizer and red light (37 J/cm2), every 1 or 2 weeks. Antifungal intake was recorded and whether a previous treatment with 40% urea was performed. Results: Twenty patients were included, 55% men, with a mean age of 59 ± 17 years. The most frequent microorganism was T rubrum (55%) and the most frequent location was the feet (90%), half associated with tinea pedis. The mean number of sessions was 6.3. Fifty percent required treatment with terbinafine 250 mg/day, although the majority (8) only for 1 month, and 3 patients with topical terbinafine achieving a resolution of 60%. Discussion: Studies support the efficacy of PDT alone or in combination with urea or different photosensitizers (methylene-blue, ALA and MAL), associated or not with keratolytics. However, there is only 1 study of PDT as adjuvant therapy demonstrating its ability to accelerate its resolution. We conclude that PDT is an alternative to the treatment of OM either in monotherapy or adjuvant, reducing the dose of antifungal agents, thus avoiding the comorbidity that it entails and achieving even higher cure rates.