Ann Dermatol.  2017 Dec;29(6):699-705. 10.5021/ad.2017.29.6.699.

Randomized Clinical Trial to Evaluate the Efficacy and Safety of Combination Therapy with Short-Pulsed 1,064-nm Neodymium-Doped Yttrium Aluminium Garnet Laser and Amorolfine Nail Lacquer for Onychomycosis

• Park KY
• Suh JH
• Kim BJ
• Kim MN
• Hong CK

• KMID: 2395176
• DOI: http://doi.org/10.5021/ad.2017.29.6.699

Abstract

BACKGROUND
Onychomycosis is one of the most prevalent fungal diseases in the general population. However, treatment is of limited effectiveness and must be administered for long periods of time. Systemic antifungal agents are associated with adverse effects.
OBJECTIVE
We evaluated the clinical efficacy and safety of a 1,064-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) laser with amorolfine nail lacquer to treat onychomycosis.
METHODS
The 128 patients were randomly divided to 2 groups: 64 in the experimental group were treated with 1,064-nm Nd:YAG laser therapy and amorolfine nail lacquer; the other 64 were in a control group treated with topical amorolfine lacquer monotherapy. The laser treatment was 4 sessions at 4-week intervals and amorolfine lacquer was applied once a week for 16 weeks. Efficacy was assessed as response rate from standardized photographs with ImagePro®Plus (Media Cybernetics, Inc., USA) analysis, microscopic examination, and subjective evaluation.
RESULTS
At 16 weeks, the experimental group showed a significantly higher cumulative cure rate than the control group (71.88% vs. 20.31%, p<0.0001). Clinical therapeutic effects were linked to patient satisfaction. The percent of "very satisfied" or "satisfied" responses was higher in the test group than the control group (81.25% vs. 23.44%). The treatment regimen was well tolerated, with transient discomfort observed in the test group.
CONCLUSION
The 1,064-nm Nd:YAG laser with amorolfine nail lacquer was effective and safe for treating onychomycosis. This therapy should be considered an alternative treatment, especially for patients with contraindications to systemic antifungal agents.

Keyword

Lasers; Onychomycosis; Therapeutics; Topical antifungal agent

MeSH Terms

Antifungal Agents
Cybernetics
Humans
Lacquer*
Laser Therapy
Onychomycosis*
Patient Satisfaction
Therapeutic Uses
Treatment Outcome
Yttrium*
Antifungal Agents
Therapeutic Uses
Yttrium

Figure

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  Fig. 1 Patient satisfaction scoring ratio.

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  Fig. 2 Representative case of combination therapy group. (A) Onychomycotic nail of big toe, on the first visit before treatment. (B) 16 weeks after starting laser treatment. Marked improvement of nail color and texture.

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  Fig. 3 Representative case of control group. (A) Onychomycotic nails of big toe, on the first visit before treatment. (B) Sixteen weeks after starting nail lacquer treatment. Subtle change in nail color and thickness.

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