Evaluation of 1,064NM ND:Yag laser treatment effectiveness in onychomycosis

Objective: Onychomycosis is a fungal infection of the nail plate or nail bed. Topical and oral antifungals, surgical or chemical excisions are the treatment options. 90% mycological cure is provided with oral treatments. However, their ability to rise liver function tests and susceptiblity to drug interactions limits their use. In recent years, laser and photodynamic treatments in onychomycosis treatment have become widespread day by day because of not having serious side effects besides their activities. In this study, it was aimed to evalate the effectiveness of 1,064 nm Nd: YAG lasers in onychomycosis. Material and Method: 30 (thirty) patients between 18-80 years of age, who were admitted to dermatology polyclinic, diagnosed with onychomycosis by potassium hydroxide (KOH) and agreed to participate were included in the study. A total of 7 laser sessions were applied to the patient's nails at one week intervals. In order to evaluate the pre- and post-treatment activities, dermatoscopic and macroscopic pictures were taken and the onychomycosis severity index was calculated. To determine the mycological cure, a control KOH study was performed 1 week after the end of treatment. The visual pain scale was used to detect the severity of pain the patients felt during laser application. Results: Of the patients included in the study, 15 (54%) were female and 13 (46%) were male. It was seen that 73.5% of the nails had no decrease in onychomycosis severity index scores and 26.5% of them had decreased (p=0.012). In the first week after treatment, KOH was positive in 37 nails (68.5%) and negative in 17 nails (31.4%) of the total 54 nails. Mycological cure rate was calculated as 31.4%. It was observed that females had more mycological improvement in their nails than males (p<0.001). When the visual pain scores were evaluated, it was seen that the patients felt increasing pain in the first sessions and decreased in the following sessions. Conclusion: We think that the 1,064 nm Nd: YAG laser alone is not effective in the treatment of onychomycosis. It may be useful in patients with systemic treatments contraindicated and patients with low onychomycosis sevirity index score. The fact that the treatment intervals and duration of a given treatment dose in studies are not bound to a certain standard which can lead to confusion in terms of practicing physicians. For this reason, there is a need for prospective controlled long-term studies to standardize treatment methods and response. Key words: Onychomycosis, Laser, 1,064nm Nd:YAG