Abstract
Onychomycosis remains difficult to cure by traditional methods. The aim of this study was to evaluate the efficacy of combination therapy with a fractional erbium yttrium aluminum garnet (Er:YAG) laser and 5 % amorolfine lacquer on onychomycosis. Nine patients with bilateral nails affected by distal and lateral subungual onychomycosis were included. The bilateral nails of each patient were divided into two groups. The 20 affected nails on one side of each patient as group 1 were treated with a fractional Er:YAG laser once a week and 5 % amorolfine lacquer twice weekly, while the 20 nails on the symmetrical side of each patient as group 2 were treated with amorolfine lacquer only. The laser treatment was conducted at weeks 1, 2, 3, 4, 8, and 12 in group 1. The clinical improvement, onychomycosis severity index (OSI), maximum linear clear nail growth (MLCNG), and mycological cure rate were evaluated. At week 24, 18 of 20 (90 %) nails in group 1 had achieved obvious clinical responses. The mean OSI score showed a significant decrease (5.24) and the average MLCNG was 3.1 mm in group 1. At week 24, 15 of 20 (75 %) nails achieved a negative mycological examination in group 1, compared with four of 20 (20 %) nails in group 2. The treatments were well-tolerated by most patients. This clinical study suggests that combination therapy of a fractional 2940-nm Er:YAG laser and 5 % amorolfine lacquer is an effective, safe, and convenient treatment method for onychomycosis.
Similar content being viewed by others
References
Dermatology CSO (2015) Guidelines on diagnosis and treatment of onychomycosis in China [in Chinese]. Chin J of Mycol 10(2):118–125
Simmons BJ, Oho AUID, Griffith RD, Falto-Aizpurua LA, Oho AUID, Nouri K (2015) An update on photodynamic therapies in the treatment of onychomycosis. J Eur Acad Dermatol Venereol 29:1275–1279
Cambuim II, Macedo DP, Delgado M, Lima KM, Mendes GP, Souza-Motta CM et al (2011) Clinical and mycological evaluation of onychomycosis among Brazilian HIV/AIDS patients. Rev Soc Bras Med Trop 44:40–42
Brenner MA, Harkless LB, Mendicino RW, Page JC (2007) Ciclopirox 8% nail lacquer topical solution for the treatment of onychomycosis in patients with diabetes: a multicenter, open-label study. J Am Podiatr Med Assoc 97:195–202
Perveze Z, Johnson MW, Rubin RA, Sellers M, Zayas C, Jones JL et al (2007) Terbinafine-induced hepatic failure requiring liver transplantation. Liver Transpl 13:162–164
Tuccori M, Bresci F, Guidi B, Blandizzi C, Del TM, Di PM (2008) Fatal hepatitis after long-term pulse itraconazole treatment for onychomycosis. Ann Pharmacother 42:1112–1117
Nijenhuis-Rosien L, Kleefstra N, Wolfhagen MJ, Groenier KH, Bilo HJ, Landman GW (2015) Laser therapy for onychomycosis in patients with diabetes at risk for foot complications: study protocol for a randomized, double-blind, controlled trial (LASER-1). Trials 16:108
Wanitphakdeedecha R, Thanomkitti K, Bunyaratavej S, Manuskiatti W (2015) Efficacy and safety of 1064-nm Nd:YAG laser in treatment of onychomycosis. J Dermatolog Treat 17:1–5
Choi MJ, Zheng Z, Goo B, Cho SB (2014) Antifungal effects of a 1444-nm neodymium:Yttrium-aluminum-garnet laser on onychomycosis: a pilot study. J Dermatolog Treat 25:294–297
Ortiz AE, Truong S, Serowka K, Kelly KM (2014) A 1,320-nm Nd: YAG laser for improving the appearance of onychomycosis. Dermatol Surg 40:1356–1360
Neev J, Nelson JS, Critelli M, McCullough JL, Cheung E, Carrasco WA et al (1997) Ablation of human nail by pulsed lasers. Lasers Surg Med 21:186–192
Choi JE, Oh GN, Kim JY, Seo SH, Ahn HH, Kye YC (2014) Ablative fractional laser treatment for hypertrophic scars: comparison between Er:YAG and CO2 fractional lasers. J Dermatolog Treat 25:299–303
Cohen JL (2013) Minimizing skin cancer surgical scars using ablative fractional Er:YAG laser treatment. J Drugs Dermatol 12:1171–1173
Carney C, Tosti A, Daniel R, Scher R, Rich P, DeCoster J et al (2011) A new classification system for grading the severity of onychomycosis: Onychomycosis Severity Index. Arch Dermatol 147:1277–1282
Ledon JA, Savas J, Franca K, Chacon A, Nouri K (2014) Laser and light therapy for onychomycosis: a systematic review. Lasers Med Sci 29:823–829
Morais OO, Costa IM, Gomes CM, Shinzato DH, Ayres GM, Cardoso RM (2013) The use of the Er:YAG 2940nm laser associated with amorolfine lacquer in the treatment of onychomycosis. An Bras Dermatol 88:847–849
Egawa M, Fukuhara T, Takahashi M, Ozaki Y (2003) Determining water content in human nails with a portable near-infrared spectrometer. Appl Spectrosc 57:473–478
Kronauer C, Gfesser M, Ring J, Abeck D (2001) Transonychial water loss in healthy and diseased nails. Acta Derm Venereol 81:175–177
Vural E, Winfield HL, Shingleton AW, Horn TD, Shafirstein G (2008) The effects of laser irradiation on Trichophyton rubrum growth. Lasers Med Sci 23:349–353
Hees H, Jager MW, Raulin C (2014) Treatment of onychomycosis using the 1 064 nm Nd:YAG laser: a clinical pilot study. J Dtsch Dermatol Ges 12:322–329
Li Y, Yu S, Xu J, Zhang R, Zhao J (2014) Comparison of the efficacy of long-pulsed Nd:YAG laser intervention for treatment of onychomycosis of toenails or fingernails. J Drugs Dermatol 13:1258–1263
Hochman LG (2011) Laser treatment of onychomycosis using a novel 0.65-millisecond pulsed Nd:YAG 1064-nm laser. J Cosmet Laser Ther 13:2–5
Xu Y, Miao X, Zhou B, Luo D (2014) Combined oral terbinafine and long-pulsed 1,064-nm Nd: YAG laser treatment is more effective for onychomycosis than either treatment alone. Dermatol Surg 40:1201–1207
Lim EH, Kim HR, Park YO, Lee Y, Seo YJ, Kim CD et al (2014) Toenail onychomycosis treated with a fractional carbon-dioxide laser and topical antifungal cream. J Am Acad Dermatol 70:918–923
Auvinen T, Tiihonen R, Soini M, Wangel M, Sipponen A, Jokinen JJ (2015) Efficacy of topical resin lacquer, amorolfine and oral terbinafine for treating toenail onychomycosis: a prospective, randomized, controlled, investigator-blinded, parallel-group clinical trial. Br J Dermatol 173:940–948
Paul C, Coustou D, Lahfa M, Bulai-Livideanu C, Doss N, Mokthar I et al (2013) A multicenter, randomized, open-label, controlled study comparing the efficacy, safety and cost-effectiveness of a sequential therapy with RV4104A ointment, ciclopiroxolamine cream and ciclopirox film-forming solution with amorolfine nail lacquer alone in dermatophytic onychomycosis. Dermatology (Basel, Switzerland) 227:157–164
Helou J, Korkomaz J, Haber R, Habre M, Tomb R (2015) Laser treatment of onychomycosis: beware of ring block anesthesia. Lasers Med Sci 30:2399–2400
Acknowledgments
We thank Dr. Kana Chen for her help in modifying the photographs and Dr. Shujie Xie for his helpful suggestions for improving the paper.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethics statement
This study was approved by the Institutional Review Board of Sun Yat-sen Memorial Hospital of Sun Yat-sen University. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
Conflict of interest
The authors declare that they have no conflict of interest.
Financial support
This study was supported by a grant from the Shenzhen Scientific and Technological Innovation Project (JCYJ20140411092351699).
Additional information
Jing Zhang and Sha Lu contributed equally to this work.
Rights and permissions
About this article
Cite this article
Zhang, J., Lu, S., Huang, H. et al. Combination therapy for onychomycosis using a fractional 2940-nm Er:YAG laser and 5 % amorolfine lacquer. Lasers Med Sci 31, 1391–1396 (2016). https://doi.org/10.1007/s10103-016-1990-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10103-016-1990-z