Query: onychomycosis nd:Yag laser

title: The use of NDYAG laser combined with pulsed light in the treatment of rosacea

title: Comparative Study of Traditional Ablative CO2 Laser Assisted Topical Antifungal with only Topical Antifungal for Treating Onychomycosis: A Multicenter Study
abstract: The predominance of onychomycosis has been increasing recently. New medications and treatment modalities are being researched for better saturation of the antifungal agents through the nail plate topically because of the low resilience of some patients for the oral antifungal agents. Treatment of onychomycosis, mainly moderate to severe, can be very challenging, expensive, and time consuming. The objective of this clinical trial is to compare the efficacy and safety of a manually operated ablative CO2 laser combined with a topical antifungal agent in patients with onychomycosis. We conducted an open label controlled prospective study of 160 eligible patients randomized into control and treatment groups with a 1:1 allocation in the department of dermatology in five different hospitals in Shanghai. It was a 6 month study where both groups were treated with a topical antifungal agent, with the treatment group also receiving ablation by the traditional CO2 laser once a month for the first 3 months. The clinical efficacy and mycological cure rate were significantly higher (p 0.001) for the treatment group. Three (3.75% patients from the control group and 18 (25% patients from the treatment group achieved complete nail clearance along with negative potassium hydroxide and negative culture (primary endpoint) results at 24 weeks. Mycological clearance with at least moderate nail clearance (secondary endpoint) for the treatment group was also significantly higher (p 0.001) for the laser treatment group. The laser treatment was mildly painful but tolerable by the patients. No drug interactions for both groups were encountered. The ablative CO2 laser is a primitive yet effective modality to be considered for the delivery of topical antifungal agents for the management of mild to severe onychomycosis. The laser has good tolerance in patients and is a common equipment found in most dermatology units even those without the latest medical technology.

title: Different Numbers of Long Pulse 1064 nm Nd YAG Laser Treatments for Onychomycosis: A Pilot Study
abstract: To examine the benefits of different numbers of 1064 nm Nd YAG laser treatments in patients with onychomycosis.  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.  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  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.

title: Ex vivo Confocal Laser Scanning Microscopy: A Potential New Diagnostic Imaging Tool in Onychomycosis Comparable With Gold Standard Techniques
abstract: Ex vivo confocal laser scanning microscopy (CLSM) is an innovative imaging tool that enables real time examination of specimens and may be used in evaluating fungal infections. We aimed to assess the applicability of ex vivo CLSM in the diagnosis of onychomycosis by comparing results to those obtained by histopathology, potassium hydroxide (KOH) examination, and fungal culture. In this prospective study, 57 patients with the clinical diagnosis of distal nail fungal infection were examined and compared using all four of the above mentioned diagnostic tools in terms of sensitivity, positive and negative predictive value. Ex vivo CLSM showed the highest sensitivity, followed by KOH examination, histopathology and fungal culture. Regarding positive and negative predictive values, ex vivo CLSM was superior and showed even higher sensitivity than the combined gold standard comprised of KOH examination, fungal culture or histopathology.

title: Fractional Carbon Dioxide Laser Plus Topical Clotrimazole versus Oral Itraconazole plus Topical Clotrimazole for Onychomycosis: A Randomized, Controlled Trial
abstract: A sample of 88 adults (between the ages of 18 and 78) was randomly divided into two groups. 45 patients received fractional CO2 laser therapy at an interval of 2 weeks and twice daily application of clotrimazole 1% cream. 43 patients were treated by pulsed itraconazole (200 mg twice daily, 1 week on, 3 weeks off) and twice daily application of clotrimazole 1% cream. The duration of the treatment was 3 months for fingernails and 4 months for toenails in both groups. The clinical effect was measured using the Scoring Clinical Index for Onychomycosis (SCIO index) KOH examination for the affected nails were performed, and liver function tests in the two groups were analyzed.

title: Randomized controlled trial comparing long pulsed 1064 Nm neodymium: Yttrium aluminum garnet laser alone, topical amorolfine nail lacquer alone, and a combination for nondermatophyte onychomycosis treatment.
abstract: Studies of the laser treatment of nondermatophyte mold (NDM) onychomycosis are limited. Long pulsed neodymium:yttrium aluminum garnet (Nd:YAG) 1064 nm laser has been introduced as an adjuvant dermatophyte onychomycosis treatment.  To investigate the efficacy and safety of long pulsed Nd:YAG 1064 nm laser for NDM onychomycosis treatment, compared with topical amorolfine nail lacquer alone and a combination treatment.  This randomized controlled trial was conducted at the Nail Clinic, Siriraj Hospital. Patients diagnosed with NDM were included and randomly assigned to three treatment groups: laser at 1 month interval (1064 nm Nd:YAG at a fluence of 35 J/cm2 pulse width 30 ms, and pulse rate 1.0 Hz) topical amorolfine nail lacquer alone; and a combination treatment.  Sixty patients completed the study. The patients treated with the laser, amorolfine, and the combination achieved mycological cure rates of 35% 60% and 65% respectively (P .05) while 10% 30% and 30% of the patients in the respective groups were clinically cured. The mean durations to the mycological cures in the patients treated with laser, amorolfine, and the combination were 5.9, 4.8, and 5.2 months, respectively. By comparison, the corresponding mean durations to the clinical cures were 6.9, 6.5, and 5.9 months. Both the times to the mycological cures and the clinical cures did not differ significantly between the groups (P .290 and P .309, respectively) There were no serious complications with the laser treatment.  Laser alone achieved only a 30% mycological cure rate for NDM onychomycosis. The combination treatment yielded similar outcomes to the topical treatment alone.

title: Comparison of a fractional 2940 nm Er:YAG laser and 5% amorolfine lacquer combination therapy versus a 5% amorolfine lacquer monotherapy for the treatment of onychomycosis: a randomized controlled trial
abstract: Onychomycosis is a fungal infection of the nail. The aim of this randomized controlled clinical trial was to compare the efficacy of 2940 nm Er:YAG laser treatment combined with a 5% amorolfine lacquer versus amorolfine monotherapy for treating onychomycosis. In this study, patients with onychomycosis of the great toenail were randomly assigned to a combination therapy group and a monotherapy group. In the combination therapy group, the included toenails were treated with a fractional 2940 nm Er:YAG laser at weeks 1, 2, 3, 4, 8, and 12, combined with a 5% amorolfine lacquer twice a week for 12 weeks, while in the monotherapy group, the included toenails were treated with only a 5% amorolfine lacquer twice a week for 12 weeks. The onychomycosis severity index (OSI) score and the mycological clearance rate (MCR) of the included toenails were assessed at baseline, week 12, and week 24. At weeks 12 and 24, the great toenails with mild and moderate onychomycosis in the combination therapy group showed obvious improvement and a greater decrease in OSI than those in the monotherapy group. At week 24, the toenails with mild and moderate onychomycosis in the combination therapy group also showed a better MCR. For the toenails with severe onychomycosis, little improvement was observed in either group at week 12 or week 24. In conclusion, fractional 2940 nm Er:YAG laser treatment combined with a 5% amorolfine lacquer is more effective than amorolfine monotherapy in short term improvement of onychomycosis.

title: Fractional CO2 laser in the management of onychomycosis
abstract: Pharmacotherapy is the standard first line management of onychomycosis (OM) Prolonged treatment courses have reported cure rates of only 40% 80% Although lasers have been approved by the US Food and Drug Administration for the clearance of nail in OM, their efficacy in the first line management is not established. In this context, we conducted a study with the aim to ascertain efficacy of fractional CO2 laser along with topical 1% terbinafine cream in the management of OM.  This was a single arm observational study in OM administered treatment over 16 weeks and analyzed at 6 months after the initiation of treatment.  Treatment naive and others after a 3 month washout period were administered fractional CO2 laser using pulse energy of 110 mJ, a density of 256 spots/cm2, pulse interval of 0.5 mm, pulse duration of 0.1 ms, and a rectangular spot size of 2 10 mm length and 0.6 5 mm breadth, every 4 weeks for four sessions along with 1% topical terbinafine cream. Outcome was assessed with Onychomycosis Severity Index (OSI) Visual Analog Score, mycological cultures and potassium hydroxide (KOH) mount at 16 weeks and 6 months after initiation of treatment.  Paired t test was used to compare the change in OSI.  Mycological evaluation at the end of 16 weeks revealed that 90% (45 nails) were KOH negative and 88% (44 nails) were culture negative. Evaluation at 6 months revealed that 86% (43 nails) were KOH negative and 88% (44 nails) were culture negative. OSI improvement compared to baseline was good to complete in 42 cases, and Visual analog Score revealed 36 nails showing 3+ 4+ improvement.  Fractional CO2 laser is a viable alternative to oral antifungals, especially when they are contraindicated such as in military aviators and in cases where drug interactions are suspected.

title: 1064 nm Nd:YAG laser treatment for onychomycosis: is it worthwhile?
abstract: Onychomycosis is a chronic fungal infection of the toenails and/or fingernails, caused by dermatophytes, yeasts, and nondermatophyte molds. Prevalences range from less than 1 to 8% in Europe and the United States, with dermatophytes being the most common causative organisms.  Most studies have found a higher prevalence in males than in females.  Although most patients only experience cosmetic concerns, nail abnormalities secondary to onychomycosis can lead to psychosocial distress and functional limitations contributing to a negative impact on quality of life.  Oral terbinafine is the first line treatment for moderate to severe dermatophyte onychomycosis. In a meta analysis, the reported mycological cure rate is around 76% [4] Although terbinafine may have advantages over itraconazole and other azoles, the latter can be used as an alternative systemic treatment option for patients who cannot tolerate terbinafine, fail to respond to terbinafine, or when yeasts are involved.  Oral treatment of onychomycosis is not desirable in many patients, e.g. due to potential hepatotoxicity, co morbidities, and drug interactions. Topical therapies have less side effects, but provide only limited efficacy due to their inability to penetrate the nail plate.  These limitations have led to research of laser and light based modalities as alternative treatment options for onychomycosis in the last decade.  A variety of laser studies are available in literature which have shown inconsistent treatment efficacy results for onychomycosis. In addition, these are not readily comparable as a result of the variable application of devices, laser settings, and outcomes (Table 1) Treatment with the neodymiumdoped/yttrium aluminum garnet (Nd:YAG) laser is one of the options to treat onychomycosis. The proposed mechanism of action uses the principle of photothermolysis. The absorption of light energy by the fungi results in the conversion of the energy into heat. Fungi are heat sensitive above 55 degC, which is likely to result in fungicidal effects. These effects may combine with laser induced modifications in the immune system or changes in the local microenvironment.  Support for the efficacy of this laser device is limited to uncontrolled studies that document clinical improvement in variable proportions of patients. The results differ from a modest 27.6% mean improvement after treatment to 80% of patients with 'moderate' to 'complete' cure.  In addition, two randomized controlled trials revealed poor results: in both studies, no statistical differences were found for onychomycosis patients treated with Nd:YAG laser versus no treatment.  In our daily practice, we tended to observe only limited treatment success with our Nd:YAG laser for onychomycosis in the 5 years patients were treated. This raised questions if onychomycosis treatment with a Nd:YAG laser is recommendable at all and, if so, which factors contribute to improvement of treatment outcomes. Therefore, we set out a retrospective cohort study to address these uncertainties.

title: 14980 Safety and clinical outcomes of the 1064 nm neodymium doped yttrium aluminum garnet laser combined with topical antifungal agents for onychomycosis in patients with diabetes mellitus