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Nd:YAG 1064 laser ineffectively treated onychomycosis

Laser therapy did not effectively treat patients with onychomycosis either through in vitro or in vivo use, according to study results.

Researchers conducted a four-part in vitro and in vivo study by using a neodymium:yttrium-aluminum-garnet (Nd:YAG) 1064-nm laser on onychomycosis. Three different nail pathogens in suspension at seven heat and time exposures comprised the study’s first segment. Pure fungal colonies were irradiated in parts two and three. Part four involved in vivo treatment of toenails of 10 patients (average age, 58 years; five men) during five treatment sessions.

At 50°C, a fungicidal effect occurred with an exposure time of 15 minutes for Trichophyton rubrum and at 10 minutes for Epidermophyton floccosum. After 5 minutes at 55°C, limited growth of Scytalidium occurred. Laser treatment of fungal colonies or suspensions did not display inhibition. There was no improvement in the Onychomycosis Severity Index score after in vivo treatment of 14 great toenails.

Researchers said the study was limited by including only one type of laser.

“In these experiments, a fungicidal effect was only achieved with heat; however, this effect would not translate to clinical treatment given the degree of the temperature and length of time needed to achieve cell death,” the researchers reported.

“Laser treatment of onychomycosis was not related to thermal damage or direct laser effects,” the researchers concluded. “In vivo treatment did not result in onychomycosis cure. Treatment of onychomycosis with laser remains an intriguing potential therapy, and additional well-designed clinical trials are needed to identify the ideal treatment parameters.”

Disclosure: Researcher Boni Elewski, MD, has received grants from Cutera and Anacor Pharmaceuticals and a grant and honoraria from Valeant Pharmaceuticals International.