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Falotico JM, Lipner SR. Updated Perspectives on the Diagnosis and Management of Onychomycosis. Clin Cosmet Investig Dermatol 2022; 15:1933-1957. [PMID: 36133401 PMCID: PMC9484770 DOI: 10.2147/ccid.s362635] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/08/2022] [Indexed: 12/02/2022]
Abstract
Onychomycosis is the most common nail disease encountered in clinical practice and can cause pain, difficulty with ambulation, and psycho-social problems. A thorough history and physical examination, including dermoscopy, should be performed for each patient presenting with nail findings suggestive of onychomycosis. Several approaches are available for definitive diagnostic testing, including potassium hydroxide and microscopy, fungal culture, histopathology, polymerase chain reaction, or a combination of techniques. Confirmatory testing should be performed for each patient prior to initiating any antifungal therapies. There are several different therapeutic options available, including oral and topical medications as well as device-based treatments. Oral antifungals are generally recommended for moderate to severe onychomycosis and have higher cure rates, while topical antifungals are recommended for mild to moderate disease and have more favorable safety profiles. Oral terbinafine, itraconazole, and griseofulvin and topical ciclopirox 8% nail lacquer, efinaconazole 10% solution, and tavaborole 5% solution are approved by the Food and Drug Administration for treatment of onychomycosis in the United States and amorolfine 5% nail lacquer is approved in Europe. Laser treatment is approved in the United States for temporary increases in clear nail, but clinical results are suboptimal. Oral fluconazole is not approved in the United States for onychomycosis treatment, but is frequently used off-label with good efficacy. Several novel oral, topical, and over-the-counter therapies are currently under investigation. Physicians should consider the disease severity, infecting pathogen, medication safety, efficacy and cost, and patient age, comorbidities, medication history, and likelihood of compliance when determining management plans. Onychomycosis is a chronic disease with high recurrence rates and patients should be counseled on an appropriate plan to minimize recurrence risk following effective antifungal therapy.
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Affiliation(s)
- Julianne M Falotico
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Shari R Lipner
- Weill Cornell Medicine, Department of Dermatology, New York, NY, USA
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2
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Gupta AK, Venkataraman M, Quinlan EM. Efficacy of Lasers for the Management of Dermatophyte Toenail Onychomycosis. J Am Podiatr Med Assoc 2022; 112:20-236. [PMID: 34233353 DOI: 10.7547/20-236] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Onychomycosis is a chronic fungal nail infection caused predominantly by dermatophytes, and less commonly by nondermatophyte molds and Candida species. Onychomycosis treatment includes oral and topical antifungals, the efficacy of which is evaluated through randomized, double-blind, controlled trials for US Food and Drug Administration approval. The primary efficacy measure is complete cure (complete mycologic and clinical cure). The secondary measures are clinical cure (usually ≤10% involvement of target nail) and mycologic cure (negative microscopy and culture). Some lasers are US Food and Drug Administration approved for the mild temporary increase in clear nail; however, some practitioners attempt to use lasers to treat and cure onychomycosis. METHODS A systematic review of the literature was performed in July of 2020 to evaluate the efficacy rates demonstrated by randomized controlled trials of laser monotherapy for dermatophyte onychomycosis of the great toenail. RESULTS Randomized controlled trials assessing the efficacy of laser monotherapy for dermatophyte toenail onychomycosis are limited. Many studies measured cure rates by means of nails instead of patients, and performed only microscopy or culture, not both. Only one included study reported mycologic cure rate in patients as negative light microscopy and culture (0%). The combined clinical cure rates in short- and long-pulsed laser studies were 13.0%-16.7% and 25.9%, respectively. There was no study that reported the complete cure rate; however, one did report treatment success (mycologic cure [negative microscopy and culture] and ≤10% clinical involvement) in nails as 16.7%. CONCLUSIONS The effectiveness of lasers as a therapeutic intervention for dermatophyte toenail onychomycosis is limited based on complete, mycologic, and clinical cure rates. However, it may be possible to use different treatment parameters or lasers with a different wavelength to increase the efficacy. Lasers could be a potential management option for older patients and onychomycosis patients with coexisting conditions such as diabetes, liver, and/or kidney diseases for whom systemic antifungal agents are contraindicated or have failed.
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Affiliation(s)
- Aditya K Gupta
- *Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,†Mediprobe Research Inc, London, Ontario, Canada
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3
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Helou J, Maatouk I, Soutou B. Big toenail onychomycosis features associated with response to 1064 nm Nd: YAG laser treatment. J Cosmet Dermatol 2021; 21:1031-1035. [PMID: 34002924 DOI: 10.1111/jocd.14233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND A few studies discussed the factors correlated to response in laser treatment of onychomycosis. OBJECTIVE This study aimed to seek big toenail onychomycosis features that correlate with response to 1064 nm Nd: YAG laser treatment. METHODS This single-center, retrospective study included patients who had only one big toenail onychomycosis, with a confirmed mycological diagnosis and/or a high clinical suspicion. Patients had three sessions 1 month apart. The following characteristics were collected from the patients' files: age, sex, smoking and arterial hypertension statuses, results of baseline mycological culture, Onychomycosis Severity Index (OSI) score at baseline and at the end of the 6-month follow-up, as well as the reported side effects. RESULTS We included 105 patients, 86 women and 19 men, with a mean age of 43 years. Demographics have shown that 73.6% of patients were smokers, 17.9% had arterial hypertension, 61.9% had a culture positive for Trichophyton species, and 9.4% had a culture positive for Candida species. According to the OSI score, onychomycosis was mild in 18.9%, moderate in 39.6%, and severe in 41.5% of patients. At 6 months, clinical cure was achieved in 57.1% of patients. CONCLUSION The OSI decrease after 3 sessions of Nd: YAG laser was significantly more important in women and in patients with positive mycology culture, smaller affected area of the nail, no subungual hyperkeratosis, and no nail matrix involvement. Age, smoking, hypertension, and side effects were not shown to significantly correlate with the decrease of the OSI score.
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Affiliation(s)
- Josiane Helou
- Dermatology Department at Hôtel-Dieu de France Hospital, School of Medicine, Université Saint-Joseph, Beirut, Lebanon
| | | | - Boutros Soutou
- Dermatology Department at Hôtel-Dieu de France Hospital, School of Medicine, Université Saint-Joseph, Beirut, Lebanon
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Gupta AK, Quinlan EM. Google search trends in onychomycosis: Influences of flip flops and advertising. J Cosmet Dermatol 2020; 19:2736-2744. [PMID: 32615640 DOI: 10.1111/jocd.13585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Onychomycosis is a fungal infection of the nail, affecting 5.5% of the population. Individuals affected by this disease experience increased anxiety about this disorder and a decreased quality of life. There are multiple available treatments across the globe, leading people to search online for information on the various therapies. AIMS To analyze Google search trends of fungal infection and treatment keywords and the influence of different geographical locations, season, regulatory decisions, and advertisements on these trends. METHODS In May, 2020 we used Google Trends to determine the relative interest of various fungal infection and treatment keywords worldwide and in the US, the UK, Canada, and Australia. Notable peaks were investigated for contemporaneous news events. RESULTS In general, searches for toenail fungus and associated treatment terms peak during the summer months. Interest in individual treatments peaks when a product is launched, is the subject of an advertising campaign, or becomes more available to the public through approval or reclassification. Yeast infection, thrush, and ringworm terms are consistently searched more often than toenail fungus, jock itch, or foot fungus; all terms are most popular in the summer months, with toenail fungus reaching annual popularity one month prior to jock itch. DISCUSSION In general, interest in toenail fungus and treatments is the highest when social anxiety about toenail appearance and the occurrence of fungal infection is the greatest. Curiosity about treatment products increases with their availability and visibility to the public. Combining the power of seasonal interest and advertising generates the greatest search profile for onychomycosis treatments.
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Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Inc., London, ON, Canada.,Department of Dermatology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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5
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Gupta A, Stec N, Summerbell R, Shear N, Piguet V, Tosti A, Piraccini B. Onychomycosis: a review. J Eur Acad Dermatol Venereol 2020; 34:1972-1990. [DOI: 10.1111/jdv.16394] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/25/2020] [Indexed: 01/25/2023]
Affiliation(s)
- A.K. Gupta
- Division of Dermatology Department of Medicine University of Toronto Toronto ON Canada
- Mediprobe Research Inc. London ON Canada
| | - N. Stec
- Mediprobe Research Inc. London ON Canada
| | - R.C. Summerbell
- Sporometrics Toronto ON Canada
- Dalla Lana School of Public Health University of Toronto Toronto ON Canada
| | - N.H. Shear
- Division of Dermatology Department of Medicine University of Toronto Toronto ON Canada
- Division of Dermatology Sunnybrook Health Sciences Centre Toronto ON Canada
| | - V. Piguet
- Division of Dermatology Department of Medicine University of Toronto Toronto ON Canada
- Division of Dermatology Women's College Hospital Toronto ON Canada
| | - A. Tosti
- Department of Dermatology and Cutaneous Surgery Leonard Miller School of Medicine University of Miami Miami FL USA
| | - B.M. Piraccini
- Dermatology Unit Department of Experimental, Diagnostic and Specialty Medicine University of Bologna Bologna Italy
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6
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Bunyaratavej S, Wanitphakdeedecha R, Ungaksornpairote C, Kobwanthanakun W, Chanyachailert P, Nokdhes YN, Patthamalai P, Tantrapornpong P, Suphatsathienkul P, Kiratiwongwan R, Limphoka P, Leeyaphan C. Randomized controlled trial comparing long-pulsed 1064-Nm neodymium: Yttrium-aluminum-garnet laser alone, topical amorolfine nail lacquer alone, and a combination for nondermatophyte onychomycosis treatment. J Cosmet Dermatol 2020; 19:2333-2338. [PMID: 31925917 DOI: 10.1111/jocd.13291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Studies of the laser treatment of nondermatophyte mold (NDM) onychomycosis are limited. Long-pulsed neodymium:yttrium-aluminum-garnet (Nd:YAG) 1064-nm laser has been introduced as an adjuvant dermatophyte onychomycosis treatment. AIMS To investigate the efficacy and safety of long-pulsed Nd:YAG 1064-nm laser for NDM onychomycosis treatment, compared with topical amorolfine nail lacquer alone and a combination treatment. PATIENTS/METHODS This randomized controlled trial was conducted at the Nail Clinic, Siriraj Hospital. Patients diagnosed with NDM were included and randomly assigned to three treatment groups: laser at 1 month interval (1064-nm Nd:YAG at a fluence of 35 J/cm2 , pulse width 30 ms, and pulse rate 1.0 Hz); topical amorolfine nail lacquer alone; and a combination treatment. RESULTS Sixty patients completed the study. The patients treated with the laser, amorolfine, and the combination achieved mycological cure rates of 35%, 60%, and 65%, respectively (P = .05), while 10%, 30%, and 30% of the patients in the respective groups were clinically cured. The mean durations to the mycological cures in the patients treated with laser, amorolfine, and the combination were 5.9, 4.8, and 5.2 months, respectively. By comparison, the corresponding mean durations to the clinical cures were 6.9, 6.5, and 5.9 months. Both the times to the mycological cures and the clinical cures did not differ significantly between the groups (P = .290 and P = .309, respectively). There were no serious complications with the laser treatment. CONCLUSIONS Laser alone achieved only a 30% mycological cure rate for NDM onychomycosis. The combination treatment yielded similar outcomes to the topical treatment alone.
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Affiliation(s)
- Sumanas Bunyaratavej
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Chanida Ungaksornpairote
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Waritch Kobwanthanakun
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pattriya Chanyachailert
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ya-Nin Nokdhes
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Poramin Patthamalai
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ploypailin Tantrapornpong
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Panittra Suphatsathienkul
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rungsima Kiratiwongwan
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pichaya Limphoka
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Charussri Leeyaphan
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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7
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Bonhert K, Dorizas A, Sadick NS. Efficacy of combination therapy with efinaconazole 10% solution and 1064 nm Nd:YAG laser for treatment of toenail onychomycosis. J COSMET LASER THER 2018; 21:179-183. [DOI: 10.1080/14764172.2018.1502451] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Krista Bonhert
- Department of Dermatology, Sadick Dermatology and Research, New York, NY
| | - Andrew Dorizas
- Dermatologic Resident, Department of Dermatology, University of Miami, FL, USA
| | - Neil S. Sadick
- Department of Dermatology, Sadick Dermatology and Research, New York, NY
- Weill-Cornell School of Medicine
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8
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Lipner SR, Scher RK. Onychomycosis: Treatment and prevention of recurrence. J Am Acad Dermatol 2018; 80:853-867. [PMID: 29959962 DOI: 10.1016/j.jaad.2018.05.1260] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/07/2018] [Accepted: 05/10/2018] [Indexed: 11/16/2022]
Abstract
Onychomycosis is a fungal nail infection caused by dermatophytes, nondermatophytes, and yeast, and is the most common nail disorder seen in clinical practice. It is an important problem because it may cause local pain, paresthesias, difficulties performing activities of daily living, and impair social interactions. The epidemiology, risk factors, and clinical presentation and diagnosis of onychomycosis were discussed in the first article in this continuing medical education series. In this article, we review the prognosis and response to onychomycosis treatment, medications for onychomycosis that have been approved by the US Food and Drug Administration, and off-label therapies and devices. Methods to prevent onychomycosis recurrences and emerging therapies are also described.
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Affiliation(s)
- Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York.
| | - Richard K Scher
- Department of Dermatology, Weill Cornell Medicine, New York, New York
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9
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Kim HJ, Park HJ, Suh DH, Lee SJ, Jeong KH, Lee MH, Shin MK. Clinical Factors Influencing Outcomes of 1064 nm Neodymium-Doped Yttrium Aluminum Garnet (Nd:YAG) Laser Treatment for Onychomycosis. Ann Dermatol 2018; 30:493-495. [PMID: 30065599 PMCID: PMC6029954 DOI: 10.5021/ad.2018.30.4.493] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/22/2017] [Accepted: 09/04/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Hyung-Jin Park
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Korea
| | | | | | - Ki-Heon Jeong
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Mu-Hyoung Lee
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Min Kyung Shin
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Korea
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10
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钟 泽, 杨 烨, 周 思, 胡 永, 毛 祖, 吴 中, 韩 雪, 刘 康, 黄 诗, 胡 燕, 卢 艳, 周 冼. [Effect of 0.9-ms 1064-nm Nd:YAG laser combined with itraconazole for treatment of toenail onychomycosis]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:358-362. [PMID: 29643045 PMCID: PMC6744175 DOI: 10.3969/j.issn.1673-4254.2018.03.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of 0.9-ms 1064-nm Nd:YAG laser alone or combined with itraconazole for treatment of toenail onychomycosis. METHODS A total of 37 patients with onychomycosis (178 toenails) were randomly assigned to groups A and B, and each group was further divided into different subgroups according to the Scoring Clinical Index of Onychomycosis (SCIO) and Onychomycosis Severity Index (OSI) scoring. All the patients were treated with 0.9-ms Nd:YAG laser once a week for 8 times. The patients in group A were treated with laser alone, and those in group B were treated with laser combined with itraconazole. The clinical effect, clinical scores, appearance of the toenails and adverse reactions in the two groups were analyzed, and the patients' satisfaction rate was also investigated. RESULTS At the 12th months of follow-up, the clinical response rate and mycological cure rate in group A were 31.33% and 30.00%, respectively, similar to the rates in group B (35.79% and 41.18%, respectively) (P>0.05). After the treatments, the SCIO and OSI scores showed no significant changes in group A (P>0.05) but both increased significantly in group B (P<0.05). The response rates did not differ significantly among the subgroups with SCIO<12 or with OSI<16 (P>0.05), but showed significant differences among the subgroups with SCIO≥12 or with OSI≥16 (P<0.05). Of the total of 178 toenails, 33.71%, 74.72% and 70.79% toenails showed improvements in terms of clear nail growth, shape and color, respectively. The overall patients' satisfaction rate was 62.16%, and no adverse reactions related with the therapy were recorded in these patients. CONCLUSION For treatment of toenail onychomycosis, 0.9-ms 1064-nm Nd:YAG laser can effectively improve the aesthetic appearance of the toenails, and a combined treatment with Nd:YAG laser and itraconazole can be better option in severe cases of onychomycosis.
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Affiliation(s)
- 泽敏 钟
- 南方医科大学第三附属医院皮肤科,广东 广州 510630Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
- 南方医科大学,广东 广州 510515Southern Medical University, Guangzhou 510515, China
| | - 烨玫 杨
- 南方医科大学第三附属医院皮肤科,广东 广州 510630Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
- 南方医科大学,广东 广州 510515Southern Medical University, Guangzhou 510515, China
| | - 思彤 周
- 南方医科大学第三附属医院皮肤科,广东 广州 510630Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
- 南方医科大学,广东 广州 510515Southern Medical University, Guangzhou 510515, China
| | - 永轩 胡
- 南方医科大学第三附属医院皮肤科,广东 广州 510630Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 祖豪 毛
- 南方医科大学第三附属医院皮肤科,广东 广州 510630Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 中 吴
- 南方医科大学第三附属医院皮肤科,广东 广州 510630Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 雪 韩
- 南方医科大学第三附属医院皮肤科,广东 广州 510630Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 康兴 刘
- 南方医科大学第三附属医院皮肤科,广东 广州 510630Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 诗韵 黄
- 南方医科大学第三附属医院皮肤科,广东 广州 510630Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 燕卿 胡
- 南方医科大学第三附属医院皮肤科,广东 广州 510630Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 艳 卢
- 南方医科大学第三附属医院皮肤科,广东 广州 510630Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 冼苡 周
- 南方医科大学第三附属医院皮肤科,广东 广州 510630Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
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11
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Khurana A, Chowdhary A, Sardana K, Gautam RK, Sharma PK. Complete cure of
Fusarium solani
sp. complex onychomycosis with Qs NdYAG treatment. Dermatol Ther 2017; 31:e12580. [DOI: 10.1111/dth.12580] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/05/2017] [Accepted: 11/01/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Ananta Khurana
- Department of DermatologyDr. RML Hospital and PGIMERNew Delhi India
| | - Anuradha Chowdhary
- Department of Medical MycologyVallabhbhai Patel Chest Institute, University of DelhiNew Delhi India
| | - Kabir Sardana
- Department of DermatologyDr. RML Hospital and PGIMERNew Delhi India
| | - R. K. Gautam
- Department of DermatologyDr. RML Hospital and PGIMERNew Delhi India
| | - P. K. Sharma
- Department of DermatologyDr. RML Hospital and PGIMERNew Delhi India
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12
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Gupta A, Versteeg S. A critical review of improvement rates for laser therapy used to treat toenail onychomycosis. J Eur Acad Dermatol Venereol 2017; 31:1111-1118. [DOI: 10.1111/jdv.14212] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/10/2017] [Indexed: 11/29/2022]
Affiliation(s)
- A.K. Gupta
- Department of Medicine; University of Toronto School of Medicine; Toronto ON Canada
- Mediprobe Research Inc.; London ON Canada
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13
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14
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Rivers JK, Vestvik BJ, Berkowitz J. Real-World Efficacy of 1064-nm Nd:YAG Laser for the Treatment of Onychomycosis. J Cutan Med Surg 2016; 21:108-113. [DOI: 10.1177/1203475416676804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Onychomycosis is a cosmetic and, at times, medical concern; therefore, effective and safe alternatives to treatment are needed. Objective: To determine the efficacy of a 1064-nm Nd:YAG laser for the treatment of onychomycosis in a real-world setting. Methods: A single-centre retrospective chart review was conducted between 2012 and 2013. One hundred consecutive patients with a culture- and/or potassium hydroxide–confirmed diagnosis of onychomycosis were treated at least twice. Baseline and follow-up photographs were taken, and the change in degree of clinical nail involvement of the subject’s great toenail was determined by a blinded reviewer using validated planimetry measurement. Results: A total of 199 hallux nails from 100 subjects were assessed. The mean infected area decreased from 53.2% at baseline to 50.8% at the end of the study (paired t test, P = .054; Wilcoxon signed rank test, P = .006). Degree of nail involvement was statistically significantly associated with amount of improvement; subjects who had the greatest degree of nail involvement improved the most, while those with less severe disease showed a worsening of nail appearance (Kruskal-Wallis test, P < .001). Three-quarters (72.6%) of nails that had more than 67% nail involvement showed statistically significant improvement (χ2 test, P = .001). Adverse events were limited to mild to moderate pain at the time of therapy. A total of 76 subjects were assessed for treatment satisfaction: 60% were very satisfied with treatment despite limited clinical improvement in some cases. Conclusions: Laser therapy has a very limited positive clinical effect on the appearance of onychomycosis after 2 treatment sessions.
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Affiliation(s)
- Jason K. Rivers
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
- Pacific Dermaesthetics, Vancouver, BC, Canada
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15
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Abstract
Many studies that have been recently published investigate the efficacy of laser treatment for onychomycosis. These studies support the current US Food and Drug Administration (FDA) approval of lasers for the 'temporary increase in clear nail'. Clear nail growth is an important treatment goal for patients; however, many do not realise that laser treatment is not a cure for onychomycosis. The current article briefly reviews why lasers may be theoretically effective in treating onychomycosis and critically reviews published laser studies for onychomycosis in light of the standards employed in drug trials. Treatment regimens, efficacy endpoints, and the unit of analysis (nails vs patients) vary widely among published laser studies. Complete cure, mycological cure, and clinical improvement rates in laser studies are not reported or use such disparate criteria that comparison among studies is not possible. The US FDA has recently published guidelines for the use of medical devices in clinical trial design for onychomycosis. Future laser studies should adopt the FDA's guidelines to allow for more consistency within the field and focus on the efficacy of lasers as monotherapy for onychomycosis.
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Affiliation(s)
- Aditya K Gupta
- 1 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- 2 Mediprobe Research, Inc, London, Ontario, Canada
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Abstract
Fungal infections, which are named according to the body site involved, can affect any skin area, the fingernails, or the toenails. Numerous fungal agents are responsible for both superficial and deep fungal diseases. Dermatophytes and Candida spp are the most common causative organisms on the surface of the hands, feet, and nails of patients with superficial fungal diseases; however, although deep fungal infections of the skin are less common compared with superficial fungal diseases, their incidence is increasing worldwide due to cross-border travel. Most superficial fungal diseases are diagnosed clinically, but sometimes direct microscopic examination with potassium hydroxide and fungal culture may be necessary for diagnosis, especially in patients suspected of having tinea incognito. In cases of superficial fungal infections except for onychomycosis and tinea incognito, topical treatments are usually sufficient and effective, but systemic treatments may be required in recalcitrant cases. Deep fungal diseases may resemble each other clinically; therefore, the organism must be identified with laboratory methods and should be treated for a long period. We review the most important clinical, diagnostic, and therapeutic aspects of fungal diseases. This paper covers fungal problems encountered both in hospitals and in general practice.
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Clinical trials of lasers for toenail onychomycosis: The implications of new regulatory guidance. J DERMATOL TREAT 2016; 28:264-270. [DOI: 10.1080/09546634.2016.1214670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Shin MK, Kim TI, Kim WS, Park HK, Kim KS. Changes in nail keratin observed by Raman spectroscopy after Nd:YAG laser treatment. Microsc Res Tech 2016; 80:338-343. [PMID: 27481603 DOI: 10.1002/jemt.22734] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/13/2016] [Accepted: 07/09/2016] [Indexed: 11/09/2022]
Abstract
Lasers and photodynamic therapy have been considered a convergence treatment for onychomycosis, which is a fungal infection on the nail bed and nail plate. Laser therapies have shown satisfactory results without significant complications for onychomycosis; however, the mechanism of clearing remains unknown. In this work, we investigated changes in the chemical structure of nail keratin induced by Nd:YAG laser using Raman spectroscopy. Toe nails with onychomycosis were treated with 1064 nm Nd:YAG laser. After laser treatment, the disulfide band (490-590 cm-1 ) of nail keratin was rarely observed or was reduced in intensity. The amide I band (1500-1700 cm-1 ) also showed changes induced by the laser. The α-helical (1652 cm-1 ) structures dominated the β-sheet (1673 cm-1 ) in nontreated nail, but the opposite phenomenon was observed after laser treatment.
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Affiliation(s)
- Min Kyung Shin
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Tae In Kim
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Wan Sun Kim
- Department of Biomedical Engineering, Graduate school, Kyung Hee University, Seoul, Korea
| | - Hun-Kuk Park
- Department of Biomedical Engineering, Graduate school, Kyung Hee University, Seoul, Korea.,Program of Medical Engineering, Kyung Hee University, Seoul, Korea.,Healthcare Industry Research Institute, Kyung Hee University, Seoul, Korea
| | - Kyung Sook Kim
- Department of Biomedical Engineering, Graduate school, Kyung Hee University, Seoul, Korea.,Program of Medical Engineering, Kyung Hee University, Seoul, Korea
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