Abstract
In the armamentarium of available treatment strategies for onychomycosis, lasers are a relatively new approach for this difficult-to-treat disorder. Although initial studies evaluating lasers for onychomycosis appeared nearly 30 years ago with the carbon dioxide (CO2) laser (Apfelberg et al., J Am Podiatry Assoc 74(10):509–513, 1984), clinical use has not gained popularity until recent years. Currently, several laser modalities are approved by the Food and Drug Administration (FDA) for the temporary increase of clear nail growth in patients with onychomycosis (Ledon et al., Laser Med Sci 29:823–829, 2014). These include the 532, 630–680, 1,064 and 1,320 nm Neodynium-doped yttrium aluminum garnet (Nd:YAG) lasers, as well as the 870/930 nm combination and 980 nm diode lasers. This chapter will provide a succinct approach to treatment of oncyhomycosis with lasers or light therapy, as well as short background on each of the laser modalities being studied for this indication.
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Notes
- 1.
Sensitivity and specificity can vary. Culture plus periodic acid-Schiff (PAS) stain is traditionally thought to be the most sensitive modality (94 %; PAS alone 85 % sensitive, no statistically significant difference), but results may take up to 6 weeks [22]. One study, however, showed that collection of subungual hyperkeratosis can lead to high diagnostic accuracy (97 %) without processing nail plates [23].
- 2.
Relative contraindication. Patients with diabetes or a known peripheral neuropathy cannot provide feedback that temperatures are too high during treatment (laser modalities). To avoid burning, they should either be treated with lower amounts of energy than the normal population, gradually increasing at each session if they tolerated the previous dosage well, or the temperature of the nail should be monitored with live temperature readings.
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Ledon, J.A., Savas, J.A., França, K., Chacon, A.H., Nouri, K. (2014). Lasers and Lights for Onychomycosis. In: Nouri, K. (eds) Handbook of Lasers in Dermatology. Springer, London. https://doi.org/10.1007/978-1-4471-5322-1_16
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