Abstract
Onychomycosis is a common fungal infection, afflicting some 10% of the adult population in industrialized countries. Aside from cosmetic concerns, onychomycosis can be the cause of toe and foot pain, as well as the underlying etiology for serious secondary bacterial infections and traumatic ulcerations. In select populations, such as diabetics, the latter conditions may even result in loss of all or part of the lower extremity. Thus, a simple, cost-effective and safe treatment for onychomycosis is highly desirable. Although both topical and oral systemic antifungal agents are available for this purpose, they are not always effective, carry some medical risks, are associated with potentially significant drug-drug interactions, and may be unacceptable to patient and healthcare provider alike. Physical modalities, such as laser therapy, therefore appear appealing. The question is whether laser treatment is sufficiently efficacious and safe to warrant the current high cost per treatment. The readily available literature on this controversy will be reviewed herein.
Highlights
Onychomycosis is a fungal infection of the nail that poses a significant treatment challenge, as it is often completely or partially refractory to approved topical and systemic medications
In 2011, Hochman designed a pilot study of eight patients with culture- or PAS-confirmed onychomycosis to be treated with 2–3 treatments of a 0.65-ms pulsed LightPod Neo neodymium-doped yttrium aluminum garnet (Nd):YAG
In addition to the lack of controlled experiments and small sample sizes enrolled in existing studies, much of the research to date is heterogeneous in design, with few sufficiently powered randomized controlled studies, making a conclusion of efficacy in laser treatment of onychomycosis difficult
Summary
Onychomycosis is a fungal infection of the nail that poses a significant treatment challenge, as it is often completely or partially refractory to approved topical and systemic medications. Estimated to affect 2%–10% of the population, onychomycosis is the most common pathology of the nail, comprising. The predominant nail pathogens are dermatophytes Trichophyton. J. Fungi 2015, 1 rubrum and Trichophyton mentagrophytes, though yeasts and non-dermatophyte molds may be etiologic, in diabetic and immunosuppressed patients. Fungi colonize the nail plate, bed, and matrix, leading to discoloration of the nail, thickening of the subungual region, and, when advanced, onycholysis [3,4]. Onychomycosis may lead to secondary bacterial infections and predispose to erysipelas and cellulitis [5]. In the diabetic population, jagged onychomycotic toenails may injure the adjacent tissue and increase the risk of foot ulcer, with sepsis or amputation a potential consequence [6]
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