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Photodynamic Therapy Combined with 1064-nm Nd:YAG Laser Therapy and Topical Efinaconazole for Refractory Onychomycosis: Case Series

  • Park, Jae Wan (Department of Dermatology, Chung-Ang University Hospital) ;
  • Koh, Young Gue (Department of Dermatology, Chung-Ang University Hospital) ;
  • Seo, Seong Jun (Department of Dermatology, Chung-Ang University Hospital) ;
  • Park, Kui Young (Department of Dermatology, Chung-Ang University Hospital)
  • Received : 2021.08.05
  • Accepted : 2021.09.07
  • Published : 2021.09.30

Abstract

Onychomycosis is the most common disease of the nail, with a worldwide prevalence of 5.5%. It causes local pain, paresthesia, and cosmetic problems and decreases the patients' quality of life. Conventional treatments include the administration of topical and systemic agents. However, factors such as subungual hyperkeratosis and biofilm formation may affect the efficacy of these treatments. Moreover, side effects associated with systemic agents are a major concern for patients. Therefore, various novel treatments are being developed; among them, photodynamic therapy (PDT) and Nd:YAG laser are promising, and several studies have demonstrated the efficacy and safety of PDT and laser therapy. Here, we report the efficacy and tolerability of PDT combined with 1064-nm Nd:YAG laser therapy and topical efinaconazole for the treatment of three patients with refractory onychomycosis.

Keywords

References

  1. de Berker D. Clinical practice. Fungal nail disease. N Engl J Med 2009;360:2108-16. https://doi.org/10.1056/NEJMcp0804878
  2. Gupta AK, Studholme C. How do we measure efficacy of therapy in onychomycosis: patient, physician, and regulatory perspectives. J Dermatolog Treat 2016;27:498-504. https://doi.org/10.3109/09546634.2016.1161156
  3. Elewski B, Pariser D, Rich P, Scher RK. Current and emerging options in the treatment of onychomycosis. Semin Cutan Med Surg 2013;32(2 Suppl 1):S9-12. https://doi.org/10.12788/j.sder.0016
  4. Graybill JR, Sharkey PK. Fungal infections and their management. Br J Clin Pract Suppl 1990;71:23-31.
  5. Bhatta AK, Keyal U, Wang XL. Photodynamic therapy for onychomycosis: a systematic review. Photodiagnosis Photodyn Ther 2016;15:228-35. https://doi.org/10.1016/j.pdpdt.2016.07.010
  6. Liddell LT, Rosen T. Laser therapy for onychomycosis: fact or fiction? J Fungi (Basel) 2015;1:44-54. https://doi.org/10.3390/jof1010044
  7. Kamp H, Tietz HJ, Lutz M, Piazena H, Sowyrda P, Lademann J, et al. Antifungal effect of 5-aminolevulinic acid PDT in Trichophyton rubrum. Mycoses 2005;48:101-7. https://doi.org/10.1111/j.1439-0507.2004.01070.x
  8. Noguchi H, Miyata K, Sugita T, Hiruma M, Hiruma M. [Treatment of onychomycosis using a 1064nm Nd:YAG laser]. Med Mycol J 2013;54:333-9. Japanese. https://doi.org/10.3314/mmj.54.333
  9. Souza LW, Souza SV, Botelho AC. Distal and lateral toenail onychomycosis caused by Trichophyton rubrum: treatment with photodynamic therapy based on methylene blue dye. An Bras Dermatol 2014;89:184-6. https://doi.org/10.1590/abd1806-4841.20142197
  10. Tardivo JP, Wainwright M, Baptista M. Small scale trial of photodynamic treatment of onychomycosis in Sao Paulo. J Photochem Photobiol B 2015;150:66-8. https://doi.org/10.1016/j.jphotobiol.2015.03.015