Combined fractional CO2 laser with topical tioconazole versus Q-switched Nd-YAG laser in the treatment of onychomycosis; a randomized comparative trial.

Autor: Sayed K; Dermatology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt., Khaled M; Dermatology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt., Gad A; Lowell General Hospital, Lowell, MA, USA.; Biostatistics and Cancer Epidemiology Department, National Cancer Institute, Cairo University, Giza, Egypt., Elbendary A; Dermatology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt. aelbendary@kasralainy.edu.eg.
Jazyk: angličtina
Zdroj: Lasers in medical science [Lasers Med Sci] 2024 Nov 12; Vol. 39 (1), pp. 274. Date of Electronic Publication: 2024 Nov 12.
DOI: 10.1007/s10103-024-04214-9
Abstrakt: Treatment of onychomycosis includes topical and systemic agents. However, prolonged use of oral treatment could cause adverse effects and topical antifungal agents have limited penetration. To compare the clinical efficacy and the safety of fractional CO 2 laser combined with topical tioconazole nail solution versus Q-switched 1064 Nd: YAG laser in the treatment of fingernail onychomycosis. This randomized comparative clinical trial was conducted on 13 patients (47 nails) with fingernail onychomycosis. Patients were randomized to receive either fractional CO2 laser combined with topical tioconazole or Q-Switched Nd: YAG 1064 nm laser every 2 weeks for 3 months followed by a 1-month follow up assessment. Onychomycosis severity index (OSI) score, Dermatology life Quality Index (DLQI) score, patient satisfaction score, dermoscopic evaluation and KOH examination were used for assessment of improvement. OSI showed improvement after treatment in both arms (from 16.17 to 10.92 in fractional CO2 arm (p = 0.026) and 23.13 to 22.43 (p = 0.92)). When comparing both groups OSI score significantly reduced in the fractional CO2 laser combined with tioconazole more than the Q-switched laser group (p = 0.002). The mean DLQI score significantly improved in both groups but no statistically significant difference between the two groups. Significant improvement in patient satisfaction score was noted in both groups. Mycological cure using KOH examination was detected in both groups (44.4% in the CO2 group and 56.5% in the Q-switched group) with no significant difference (P value < 0.05). Ruin pattern keratosis found to be the most dermoscopic pattern to be associated with poor OSI score improvement. Fractional CO2 laser combined with topical tioconazole is more efficient in treatment of onychomycosis than Q-Switched Nd: YAG 1064 nm laser group as regards clinical improvement but both have comparable effect on mycological cure. Their use as adjuvant treatment rather than alone is recommended to ensure mycological cure in onychomycosis.
Competing Interests: Declarations Ethical approval The study has been approved by the ethical committee of both the Department Scientific and Ethical Committee Boards of Kasr Alainy Faculty of Medicine, Cairo University. Informed consent Will be sent upon request. Conflict of interest The authors have no relevant financial or non-financial interests to disclose.
(© 2024. The Author(s).)
Databáze: MEDLINE
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