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Journal of the American Academy of Dermatology
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le dimanche 14 juillet 2013
Doi : 10.1016/j.jaad.2013.04.054
accepted : 15 April 2013
Treatment of onychomycosis using a submillisecond 1064-nm neodymium:yttrium-aluminum-garnet laser
 

Caitlin Carney, MD, Wendy Cantrell, CRNP, DNP, Judy Warner, BA, Boni Elewski, MD
 University of Alabama at Birmingham, Birmingham, Alabama 

Reprint requests: Boni Elewski, MD, University of Alabama at Birmingham, EFH 414-Dermatology, 1530 Third Ave S, Birmingham, AL 35294-0009.
Abstract
Background

Laser treatment has emerged as a novel treatment modality for onychomycosis.

Objective

We sought to determine thermal response and optical effects of a submillisecond neodymium:yttrium-aluminum-garnet (Nd:YAG) 1064-nm laser on common fungal nail pathogens, and the clinical efficacy and safety of the Nd:YAG 1064-nm laser on onychomycotic toenails.

Methods

A 4-part in vitro and in vivo study was conducted using a Nd:YAG 1064-nm laser. The first portion evaluated 3 different nail pathogens in suspension at 7 heat and time exposures. The second and third parts of the study irradiated pure fungal colonies. The final portion involved an in vivo treatment of toenails over 5 treatment sessions.

Results

A fungicidal effect for Trichophyton rubrum was seen at 50°C after 15 minutes, and for Epidermophyton floccosum at 50°C after 10 minutes. Limited growth of Scytalidium was seen at 55°C after 5 minutes. No inhibition was observed after laser treatment of fungal colonies or suspensions. In vivo treatment of toenails showed no improvement in Onychomycosis Severity Index score.

Limitations

The Nd:YAG 1064-nm laser was the only laser tested.

Conclusions

Laser treatment of onychomycosis was not related to thermal damage or direct laser effects. In vivo treatment did not result in onychomycosis cure.

The full text of this article is available in PDF format.

Key words : fungal, irradiation, laser, neodymium:yttrium-aluminum-garnet, onychomycosis, Onychomycosis Severity Index, thermal

Abbreviations used : CFU, Nd:YAG, OSI



 Supported by Cutera Inc, Brisbane, CA.
 Disclosure: Dr Elewski has received grants from Cutera Inc and Anacor Pharmaceuticals Inc, and a grant and honoraria from Valeant Pharmaceuticals International Inc. Drs Carney and Cantrell and Ms Warner have no conflicts of interest to declare.
 In vitro results were presented as a poster at the American Academy of Dermatology Annual Meeting, Miami Beach, FL, March 5-10, 2010.



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