Evaluation of ND:Yag laser activity in onychomycosis treatment

Objective: Onychomycosis is the most commonly diagnosed nail disease and is a fungal infection of the nail plate and subungual area. Clinical signs of onychomycosis are subungual hyperkeratosis, trachionism, onycholysis, discoloration and increased fragility. There are many treatment modalities which are applied for onychomycosis. Treatment successes of topical antifungal agents used in the treatment of onychomycosis are low. Systemic antifungal treatment is more effective but has adverse effects such as difficulty with patient compliance when long-term administration is needed, hepatic and renal toxicity risks and drug interactions. This situation increases the need for more effective monotherapies or a method of helping existing treatments. UV-therapy, photodynamic therapy and laser devices have been used for onychomycosis in recent years as a non-pharmacological treatment. We aimed to evaluate the effectiveness of 1064 nm long-pulsed Nd:YAG laser therapy to treat patients with onychomycosis in this study. Material and Method: Clinical and mycological diagnosed a total of 50 patients (25 males, 25 females) who were positive for at least one of the standard KOH and 24-hour KOH tests were included in the study. A total of 50 patients, 25 were males (50%) and 25 were females (50%). The mean age of the cases was 38,98±13,50. Duetto MT EVO branded which has long-pulsed and 1064 nm Nd:YAG laser device was used. Patients were treated for 3 sessions in total with 4 weeks interval. Standard dose Nd:YAG laser therapy was applied with 4 mm spot size, 13 milliseconds pulse duration, 1 Hz repetation rate, 40 joules/cm2 fluence. Cooling spray, gel, analgesic and topical anesthetic were not used. One month after the end of treatment, the patients were reapplied with standard KOH and 24-hour KOH tests. The treatment efficacy was evaluated by comparing the KOH positivity before and after the treatment. Results: The KOH test was negative in 4 patients (8%) after 1 month of treatment. In 46 patients (92%), the KOH test was positive. As a result, there was no statistically significant correlation between post-treatment KOH test and pre-treatment KOH test positivity (p=0,736). No side effects of treatment were observed in the patients. Conclusion: In this study, the treatment efficacy was found to be 8%. We conclude that the Nd:YAG laser can not be used as an effective treatment option for onychomycosis when applied with these parameters. Keywords: Nd:YAG Laser, Treatment, Onychomycosis.