Different Numbers of Long-Pulse 1064-nm Nd-YAG Laser Treatments for Onychomycosis: A Pilot Study

Rui-Na Zhang,Lin-Feng Li,Dong-Kun Wang,Feng-Lin Zhuo,Li-Zhi Ma,Jun-Ying Zhao

doi:10.1155/2020/1216907

Rui-Na Zhang, Lin-Feng Li + Show 4 more

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https://doi.org/10.1155/2020/1216907

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Abstract

Purpose To examine the benefits of different numbers of 1064-nm Nd-YAG laser treatments in patients with onychomycosis. Methods This was a pilot study of patients with onychomycosis who were divided into three groups: four treatment sessions (group A), eight sessions (group B), and 12 sessions (group C). Only infected nails of degrees II–III (Scoring Clinical Index for Onychomycosis) were included. Treatment was given once a week using a long-pulse Nd-YAG 1064-nm laser. Patients were followed at 8, 16, and 24 weeks after the first treatment. Side effects were recorded. Results Treatments were completed for 442 nails in 102 patients. The efficacy rates at 8, 16, and 24 weeks were 35.5%, 38.7%, and 37.4% for group A; 31.4%, 41.7%, and 44.0% for group B; and 27.7%, 50.0%, and 55.4% for group C, respectively. There was a significant difference in the efficacy rate at 24 weeks (P = 0.016) between groups A and C, but not for groups A vs. B, or for groups B vs. C. No difference in the efficacy rate at 8 or 16 weeks was observed among the three groups. In all three groups, the efficacy was better for degree II nails than for degree III nails (all P = 0.016) between groups A and C, but not for groups A vs. B, or for groups B vs. C. No difference in the efficacy rate at 8 or 16 weeks was observed among the three groups. In all three groups, the efficacy was better for degree II nails than for degree III nails (all Conclusions The 1064-nm Nd-YAG laser had clinical benefits against onychomycosis. Higher numbers of treatments provided better long-term (24-week) benefits, but had no impact on the short-term outcomes. The efficacy of laser treatment on degree II onychomycosis was better than for degree III.

Highlights

Onychomycosis is a persistent fungal infection of the nail bed and plate and is most commonly (85–90%) caused by dermatophytes such as Trichophyton rubrum [1, 2]. e worldwide incidence of onychomycosis is approximately 3–5% [3, 4] and increases with age [5]
We used the SCIO for evaluating the severity of onychomycosis
We found that the efficacy rate was negatively correlated with the SCIO index

Summary

Introduction

Onychomycosis is a persistent fungal infection of the nail bed and plate and is most commonly (85–90%) caused by dermatophytes such as Trichophyton rubrum [1, 2]. e worldwide incidence of onychomycosis is approximately 3–5% [3, 4] and increases with age [5]. Common antifungal drugs for external use or oral administration used for the treatment of onychomycosis include fluconazole, itraconazole, and terbinafine [1, 2, 6], but topical antifungal agents barely penetrate the nail plate and do not achieve local therapeutic concentrations, and systemic oral antifungal medications are not applicable for some patients with abnormal liver function or low immune function [8,9,10]. A previous study showed that the long-pulse neodymium-doped yttrium aluminum garnet (Nd-YAG) laser at a wavelength of 1064 nm (Beijing Shiji Guangtong Biotechnology Co., Ltd.) used for the treatment of 154 infected nails in 33 patients could cure 52% of the nails [17]. Many studies have confirmed that the 1064-nm Nd-YAG laser is effective against onychomycosis [11, 18,19,20]. e advantages of this laser include long wavelength, high energy, simple operation, strong penetrability, and no mutagenesis effect on cell DNA [18]

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