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


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.


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



distolateral subungual onychomycosis


Food and Drug Administration


neodymium-doped: yttrium-aluminum-garnet


neodymium-doped: yttrium-aluminum-perovskite




randomized controlled trial


total dystrophic onychomycosis


unit of analysis


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)


  1. 1.
    Lipner SR, Scher RK (2019) Onychomycosis: clinical overview and diagnosis. J Am Acad Dermatol 80(4):835–851CrossRefPubMedGoogle Scholar
  2. 2.
    Drake LA, Scher RK, Smith EB, Faich GA, Smith SL, Hong JJ et al (1998) Effect of onychomycosis on quality of life. J Am Acad Dermatol 38(5 Pt 1):702–704CrossRefPubMedGoogle Scholar
  3. 3.
    Liddell L, Rosen T (2015) Laser therapy for onychomycosis: fact or fiction? J Fungi 1(1):44–54CrossRefGoogle Scholar
  4. 4.
    Ghannoum M, Isham N (2014) Fungal nail infections (onychomycosis): a never-ending story? PLoS Pathog 10(6)Google Scholar
  5. 5.
    Ameen M, Lear J, Madan V, Mohd Mustapa M, Richardson M, Ameen M.2014 British Association of Dermatologists’ guidelines for the management of onychomycosis 2014 Conflicts of interest ;Google Scholar
  6. 6.
    Westerberg DP, Voyack MJ (2013) Onychomycosis: current trends in diagnosis and treatment. Am Fam Physician 88(11):762–770PubMedGoogle Scholar
  7. 7.
    Crawford F, Hollis S (2007) Topical treatments for fungal infections of the skin and nails of the foot. Cochrane Database Syst Rev (3):CD001434Google Scholar
  8. 8.
    Kreijkamp-Kaspers S, Hawke K, Guo L, Kerin G, Bell-Syer SE, Magin P et al (2017) Oral antifungal medication for toenail onychomycosis. Cochrane Database Syst Rev 7(7):CD010031PubMedGoogle Scholar
  9. 9.
    Baran R, Sigurgeirsson B, Berker D de, Kaufmann R, Lecha M, Faergemann J, et al. A multicentre, randomized, controlled study of the efficacy, safety and cost-effectiveness of a combination therapy with amorolfine nail lacquer and oral terbinafine compared with oral terbinafine alone for the treatment of onychomycosis with matrix involvement. Br J Dermatol 2007 1;157(1):149–157Google Scholar
  10. 10.
    Avner S, Nir N, Henri T (2005) Combination of oral terbinafine and topical ciclopirox compared to oral terbinafine for the treatment of onychomycosis. J Dermatolog Treat 16(5–6):327–330CrossRefPubMedGoogle Scholar
  11. 11.
    Gupta A, Lynch L (2004) Onychomycosis: review of recurrence rates, poor prognostic factors, and strategies to prevent disease recurrence. Cutis. 74(Suppl. 1):5–10PubMedGoogle Scholar
  12. 12.
    Landsman AS, Robbins AH, Angelini PF, Wu CC, Cook J, Oster M et al (2010) Treatment of mild, moderate, and severe onychomycosis using 870- and 930-nm light exposure. J Am Podiatr Med Assoc 100(3):166–177CrossRefPubMedGoogle Scholar
  13. 13.
    Hollmig ST, Rahman Z, Henderson MT, Rotatori RM, Gladstone H, Tang JY (2014) Lack of efficacy with 1064-nm neodymium:yttrium-aluminum-garnet laser for the treatment of onychomycosis: a randomized, controlled trial. J Am Acad Dermatol 70(5):911–917CrossRefPubMedGoogle Scholar
  14. 14.
    Carney C, Cantrell W, Warner J, Elewski B (2013) Treatment of onychomycosis using a submillisecond 1064-nm neodymium:yttrium-aluminum-garnet laser. J Am Acad Dermatol 69(4):578–582CrossRefPubMedGoogle Scholar
  15. 15.
    Zhang RN, Dk W, Zhuo FL, Duan XH, Zhang XY, Zhao JY (2012) Long-pulse Nd:YAG 1064-nm laser treatment for onychomycosis. Chin Med J 125(18):3288–3291PubMedGoogle Scholar
  16. 16.
    Moon SH, Hur H, Oh YJ, Choi KH, Kim JE, Ko JY et al (2014) Treatment of onychomycosis with a 1,064-nm long-pulsed Nd:YAG laser. J Cosmet Laser Ther 16(4):165–170CrossRefPubMedGoogle Scholar
  17. 17.
    Wanitphakdeedecha R, Thanomkitti K, Bunyaratavej S, Manuskiatti W (2016) Efficacy and safety of 1064-nm Nd:YAG laser in treatment of onychomycosis. J Dermatolog Treat 27(1):75–79CrossRefPubMedGoogle Scholar
  18. 18.
    Hees H, Jäger MW, Raulin C (2014) Treatment of onychomycosis using the 1 064 nm Nd:YAG laser: a clinical pilot study. JDDG J der Dtsch Dermatologischen Gesellschaft 12(4):322–329Google Scholar
  19. 19.
    Zhou BR, Lu Y, Permatasari F, Huang H, Li J, Liu J et al (2016) The efficacy of fractional carbon dioxide (CO2) laser combined with luliconazole 1% cream for the treatment of onychomycosis A randomized, controlled trial. Med (United States) 95(44)Google Scholar
  20. 20.
    Bhatta AK, Keyal U, Huang X, Zhao JJ (2016) Fractional carbon-dioxide (CO2) laser-assisted topical therapy for the treatment of onychomycosis. J Am Acad Dermatol 74(5):916–923CrossRefPubMedGoogle Scholar
  21. 21.
    Shi J, Li J, Huang H, Permatasari F, Liu J, Xu Y et al (2017) The efficacy of fractional carbon dioxide (CO2) laser combined with terbinafine hydrochloride 1% cream for the treatment of onychomycosis. J Cosmet Laser Ther 19(6):353–359CrossRefPubMedGoogle Scholar
  22. 22.
    FDA. Medical devices and clinical trial design for the treatment or improvement in the appearance of fungally-infected nails; draft guidance for Industry and Food and Drug Administration Staff; Availability. 2016;81(44):29Google Scholar
  23. 23.
    Nenoff P, Grunewald S, Paasch U (2014) Laser therapy of onychomycosis. JDDG - J Ger Soc Dermatology 12(1):33–38Google Scholar
  24. 24.
    Moga C, Guo B, Schopflocher D, Harstall C (2012) Development of a quality appraisal tool for case series studies using a modified Delphi technique. Edmont AB Inst Heal Econ (March)Google Scholar
  25. 25.
    Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ Br Med J 327(7414):557–560CrossRefGoogle Scholar
  26. 26.
    Higgins J, Green S.2011 Cochrane handbook for systematic reviews of interventions. Vol. Vers5.1.0, The Cochrane Collaboration. . 672 pGoogle Scholar
  27. 27.
    Kozarev J, Vižintin Z (2010) Novel laser therapy in treatment of onychomycosis. J Laser Heal Acad 2010(1):1–8Google Scholar
  28. 28.
    Kolodchenko YV, Baetul VI (2013) A novel method for the treatment of fungal nail disease with 1064 nm Nd:YAG. J Laser Heal Acad 2013(1):42–47Google Scholar
  29. 29.
    Heck R, Rossi C, Kuhl ICP, Bakos L (2013) Treatment of dermatophyte onychomy cosis of the haluces with 1064 Nd : YAG laser. Surg Cosmet Dermatology 5(3):257–260Google Scholar
  30. 30.
    Kim MS, Jung JY, Cho EB, Park EJ, Kim KH, Kim KJ (2016) The effectiveness of 1,064-nm long-pulsed Nd:YAG laser in the treatment of severe onychomycosis. J Cosmet Laser Ther 18(6):317–322CrossRefPubMedGoogle Scholar
  31. 31.
    Kimura U, Takeuchi K, Kinoshita A, Takamori K, Hiruma M, Suga Y (2012) Treating onychomycoses of the toenail: clinical efficacy of the sub-millisecond 1,064 nm Nd: YAG laser using a 5 mm spot diameter. J Drugs Dermatol 11(4):496–504PubMedGoogle Scholar
  32. 32.
    Kalokasidis K, Onder M, Trakatelli MG, Richert B, Fritz K (2013) The effect of Q-switched Nd:YAG 1064 nm/532 nm laser in the treatment of onychomycosis in vivo. Dermatol Res Pract 2013Google Scholar
  33. 33.
    Noguchi H, Miyata K, Sugita T, Hiruma M, Hiruma M (2013) Treatment of onychomycosis using a 1064nm Nd:YAG laser. Med Mycol J 54(4):333–339CrossRefPubMedGoogle Scholar
  34. 34.
    El-Tatawy RA, Abd El-Naby NM, El-Hawary EE, Talaat RAZ (2015) A comparative clinical and mycological study of Nd-YAG laser versus topical terbinafine in the treatment of onychomycosis. J Dermatolog Treat 26(5):461–464CrossRefPubMedGoogle Scholar
  35. 35.
    Kim TI, Shin MK, Jeong KH, Suh DH, Lee SJ, Oh IH et al (2016) A randomised comparative study of 1064 nm neodymium-doped yttrium aluminium garnet (Nd:YAG) laser and topical antifungal treatment of onychomycosis. Mycoses. 59(12):803–810CrossRefPubMedGoogle Scholar
  36. 36.
    Espírito-Santo GA Do, Leite DP, Hoffmann-Santos HD, Dias LB, Hahn RC. 1340nm laser therapy for onychomycosis: negative results of prospective treatment of 72 toenails and a literature review. J Clin Aesthet Dermatol 2017;10(8):56–61Google Scholar
  37. 37.
    Okan G, Tarikci N, Gokdemir G (2017) The effect of long-pulsed Nd:YAG laser for the treatment of onychomycosis. J Am Podiatr Med Assoc 107(1):54–59CrossRefPubMedGoogle Scholar
  38. 38.
    Zalacain A, Merlos A, Planell E, Cantadori EG, Vinuesa T, Viñas M (2017) Clinical laser treatment of toenail onychomycoses. Lasers Med Sci:1–7Google Scholar
  39. 39.
    Piccolo D, Kostaki D, Del Duca E, Cannarozzo G, Sannino M, Nisticò S (2017) Long-pulsed 1064-nm Nd:YAG laser for the treatment of onychomycosis. Photomed Laser Surg 35(4):213–216CrossRefPubMedGoogle Scholar
  40. 40.
    Leverone AP, Guimarães DA, Bernardes-Engemann AR, Orofino-Costa R. Laser treatment of onychomycosis due to Neoscytalidium dimidiatum: an open prospective study. Med Mycol 2018 1;56(1):44–50Google Scholar
  41. 41.
    Ibrahim SA, Albalat W, Ebrahim HM (2018) Evaluation of long pulsed Nd-YAG laser in the treatment of onychomycosis. J Cosmet Laser Ther 16:1–6Google Scholar
  42. 42.
    Loo DS (2007) Onychomycosis in the elderly : drug treatment options. Drugs Aging 24(4):293–302CrossRefPubMedGoogle Scholar
  43. 43.
    Bristow IR (2014) The effectiveness of lasers in the treatment of onychomycosis: a systematic review. J Foot Ankle Res 7(1)Google Scholar
  44. 44.
    Francuzik W, Fritz K, Salavastru C (2016) Laser therapies for onychomycosis—critical evaluation of methods and effectiveness. J Eur Acad Dermatology Venereol 30(6):936–942CrossRefGoogle Scholar
  45. 45.
    Gupta AK, Versteeg SG (2017) A critical review of improvement rates for laser therapy used to treat toenail onychomycosis. J Eur Acad Dermatology Venereol 31(7):1111–1118CrossRefGoogle Scholar
  46. 46.
    Ledon JA, Savas J, Franca K, Chacon A, Nouri K (2014) Laser and light therapy for onychomycosis: a systematic review. Lasers Med Sci 29(2):823–829CrossRefPubMedGoogle Scholar
  47. 47.
    Wiznia LE, Quatrano NA, Mu EW, Rieder EA (2017) A clinical review of laser and light therapy for nail psoriasis and onychomycosis. Dermatologic Surg 43(2):161–172CrossRefGoogle Scholar
  48. 48.
    Ortiz AE, Avram MM, Wanner MA (2014) A review of lasers and light for the treatment of onychomycosis. Lasers Surg Med 46(2):117–124CrossRefPubMedGoogle Scholar
  49. 49.
    Bhatta AK, Huang X, Keyal U, Zhao JJ (2014) Laser treatment for onychomycosis: a review. Mycoses. 57(12):734–740CrossRefPubMedGoogle Scholar
  50. 50.
    Liu C, Zhang L, Zeng HY, Bei H, Chen SP, Wu YX et al (2018) The energy density and treatment times are the main factors that affect the efficacy of long-pulsed 1,064-nm Nd:YAG laser treatment for onychomycosis caused by trichophyton rubrum. Dermatology. 234(3–4):105–111CrossRefPubMedGoogle Scholar
  51. 51.
    Albengres E, Le Louët H, Tillement JP (1998) Systemic antifungal agents. Drug interactions of clinical significance. Drug Saf 18(2):83–97CrossRefPubMedGoogle Scholar
  52. 52.
    He W, Goodkind D, Kowal P (2016) An aging world: 2015 international population reports. Aging (Albany NY):165Google Scholar

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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