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Lasers in Medical Science

, Volume 34, Issue 8, pp 1513–1525 | Cite as

Efficacy of laser treatment for onychomycotic nails: a systematic review and meta-analysis of prospective clinical trials

  • Kelvin Yeung
  • Vinzent Kevin OrtnerEmail author
  • Torben Martinussen
  • Uwe Paasch
  • Merete Haedersdal
Review Article

Abstract

Laser therapy for onychomycosis is emerging but its efficacy remains unestablished. To examine current evidence on efficacy of laser treatment of onychomycosis. A systematic review and one-arm meta-analysis, including all prospective clinical trials, identified on PubMed, Cochrane Library, and EMBASE databases. Trials with participants as unit of analysis (UOA), n = 13, were analyzed separately from trials with nails as UOA, n = 7. Summary proportions and 95% confidence intervals (95% CI) were calculated. Outcomes were mycological cure, clinical improvement, or complete cure. Twenty-two prospective trials (four randomized controlled trials and 18 uncontrolled trials) with a total of 755 participants were analyzed. Summary proportions with 95% CI for participants as UOA were mycological cure 70.4%, 95% CI 52.2–83.8%; clinical improvement 67.2%, 95% CI 43.2–84.7%; and complete cure 7.2%, 95% CI 1.9–23.5%. High statistical heterogeneity was detected (mycological cure I2 = 88%, P < 0.01; clinical improvement I2 = 69%, P < 0.01; complete cure I2 = 60%, P = 0.11). The current level of evidence is limited and with high heterogeneity, making it difficult to assess the true efficacy of laser treatment for onychomycosis. Larger randomized controlled trials with well-defined methodology are warranted.

Keywords

Onychology Laser Mycology Systematic review Meta-analysis Evidence-based medicine 

Abbreviations

DLSO

distolateral subungual onychomycosis

FDA

Food and Drug Administration

Nd:YAG

neodymium-doped: yttrium-aluminum-garnet

Nd:YAP

neodymium-doped: yttrium-aluminum-perovskite

OM

onychomycosis

RCT

randomized controlled trial

TDO

total dystrophic onychomycosis

UOA

unit of analysis

Notes

Compliance with ethical standards

Conflict of interest

VK Ortner has received research grants from LeoPharma and InnovationFund Denmark. M Haedersdal has received research grants from Sebacia Inc., Procter & Gamble, Lutronic, LeoPharma and Galderma.

Supplementary material

10103_2019_2802_MOESM1_ESM.docx (33 kb)
ESM 1 (DOCX 33 kb)
10103_2019_2802_MOESM2_ESM.docx (58 kb)
ESM 2 (DOCX 58 kb)

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Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Dermatology and VenereologyBispebjerg Hospital, University of CopenhagenCopenhagenDenmark
  2. 2.Section of Biostatistics, Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
  3. 3.Department of Dermatology, Venereology, and AllergologyUniversity of LeipzigLeipzigGermany

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