Is Nd:YAG Laser Effective in the Treatment of Onychomycosis?

Yıl 2021, Cilt: 5 Sayı: 1, 13 - 21, 20.04.2021

Serkan Düzayak , Orhan Özgöztaşı

https://doi.org/10.46332/aemj.823260

Öz

Purpose: The treatment of onychomycosis is low. Systemic antifungal treatment is more effective but has adverse effects such as hepatic and renal toxicity risks and drug interactions. We aimed to evaluate the effectiveness of 1064nm long-pulsed Nd:YAG laser therapy to treat patients with onychomycosis in this study.

Material and Methods: 50 patients (25 males, 25 females) who were diagnosed with the disease were included in the study. A total of 50 patients, 25 were males and 25 were females. 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. 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 cannot be used as an effective treatment option for onychomycosis when applied with these parameters.

Anahtar Kelimeler

KOH Test, nail fungal infection, long pulsed ND:YAG laser

Nd:YAG Lazer Onikomikoz Tedavisinde Etkili midir?

Öz

Amaç: Onikomikoz tırnak plağı ve subungual alanın tutulduğu bir fungal enfeksiyondur. Onikomikoz tedavisinde kullanılan topikal antifungal ajanların tedavi başarıları düşüktür. Sistemik antifungal tedavi daha etkilidir ancak hepatik ve renal toksisite riski, ilaç etkileşimleri gibi yan etkilere sahiptir. Bu çalışmamızda onikomikozlu hastaları tedavi etmek için 1064-nm long-pulsed (uzun atımlı) Nd:YAG lazerin etkinliğini değerlendirmeyi amaçladık.

Araçlar ve Yöntem: Hastalığın tanısı konulmuş 25 erkek, 25 kadın toplam 50 hasta tedaviye alındı. Duetto MT EVO uzun atımlı 1064 nm Nd:YAG lazer cihazı kullanıldı. Hastalar 4 hafta arayla toplam 3 seans tedavi edildi. 4 mm uygulama genişliği, 13 milisaniye atım süresi, 1 Hz tekrarlama hızı, 40 joule/cm2 standart dozunda Nd:YAG lazer tedavisi uygulandı. Tedavi öncesi ve tedavi bitiminden 1 ay sonraki KOH pozitiflikleri istatistiksel olarak karşılaştırılarak tedavi etkinliği değerlendirildi.

Bulgular: Tedaviden 1 ay sonra 4 hastada (%8) KOH testi negatif bulundu. 46 hastada (%92) ise KOH testi pozitif bulundu. Sonuç olarak tedavi sonrası KOH testi ile tedavi öncesi KOH testi pozitiflikleri arasında istatistiksel olarak anlamlı bir ilişki görülmemiştir (p=0,736). Hastalarda tedaviye ait hiçbir yan etki gözlenmedi.

Sonuç: Bu çalışmada tedavi etkinliğini %8 olarak bulduk. Nd:YAG lazer’in bu parametrelerle uygulandığında onikomikoz için etkin bir tedavi seçeneği olarak kullanılamayacağı görüşündeyiz.

Anahtar Kelimeler

KOH testi, tırnak mantarı, uzun atımlı ND:YAG lazer

Kaynakça

• 1. Bueno JG, Martinez C, Zapata B, Sanclemente G, Gallego M, Mesa AC. In vitro activity of fluconazole, itraconazole, voriconazole and terbinafine against fungi causing onychomycosis. Clin Exp Dermatol. 2010;35(6):658-663.
• 2. Ledon JA, Savas J, Franca K, Chacon A, Nouri K. Laser and light therapy for onychomycosis: A systematic review. Lasers Med Sci. 2014;29(2):823-829.
• 3. Helou J, Maatouk I, Hajjar MA, Moutran R. Evaluation of Nd: YAG laser device efficacy on onychomycosis: A case series of 30 patients. Mycoses. 2016;59(1):7-11.
• 4. Zhang R na, Wang D kun, Zhuo F lin, Duan X han, Zhang X yan, Zhao J ying. Long-pulse Nd:YAG 1064-nm laser treatment for onychomycosis. Chin Med J (Engl). 2012;125(18):3288-3291.
• 5. Gupta AK, Simpson FC, Heller DF. The future of lasers in onychomycosis. J Dermatolog Treat. 2016;27(2):167-172.
• 6. Carney C, Cantrell W, Warner J, Elewski B. Treatment of onychomycosis using a submillisecond 1064-nm neodymium:yttrium-aluminum-garnet laser. J Am Acad Dermatol. 2013;69(4):578-582.
• 7. IBM Corp. IBM SPSS Statistics V24. Published online 2016.
• 8. Wanitphakdeedecha R, Thanomkitti K, Bunyaratavej S, Manuskiatti W. Efficacy and safety of 1064-nm Nd:YAG laser in treatment of onychomycosis. J Dermatolog Treat. 2016;27(1):75-79.
• 9. Kurtoǧlu F, Yildiz L, Şentürk N, et al. Comparison of diagnostic methods for onychomycosis: A controlled, prospective study. Turk Dermatoloji Derg. 2011;5(2):48-52.
• 10. Hees H, Jäger MW, Raulin C. Treatment of onychomycosis using the 1 064 nm Nd:YAG laser: a clinical pilot study. JDDG J der Dtsch Dermatologischen Gesellschaft. 2014;12(4):322-329.
• 11. Hochman LG. Laser treatment of onychomycosis using a novel 0.65-millisecond pulsed Nd:YAG 1064-nm laser. J Cosmet Laser Ther. 2011;13(1):2-5.
• 12. Hollmig ST, Rahman Z, Henderson MT, Rotatori RM, Gladstone H, Tang JY. Lack of efficacy with 1064-nm neodymium:yttrium-aluminum-garnet laser for the treatment of onychomycosis: A randomized, controlled trial. J Am Acad Dermatol. 2014;70(5):911-917.
• 13. Moon SH, Hur H, Oh YJ, et al. Treatment of onychomycosis with a 1,064-nm long-pulsed Nd:YAG laser. J Cosmet Laser Ther. 2014;16(4):165-170.
• 14. Noguchi H, Miyata K, Sugita T, Hiruma M, Hiruma M. Treatment of onychomycosis using a 1064nm Nd:YAG laser. Japanese J Med Mycol. 2013;54(4):333-339.
• 15. Kimura U, Takeuchi K, Kinoshita A, Takamori K, Hiruma M, Suga Y. Treating onychomycoses of the toenail: clinical efficacy of the sub-millisecond 1,064 nm Nd: YAG laser using a 5 mm spot diameter. J Drugs Dermatol. 2012;11(4):496-504.
• 16. Zhang RN, Zhuo FL, Wang DK, Ma LZ, Zhao JY, Li LF. Different Numbers of Long-Pulse 1064-nm Nd-YAG Laser Treatments for Onychomycosis: A Pilot Study. Biomed Res Int. 2020;2020, , Article ID 1216907.
• 17. Landsman AS, Robbins AH, Angelini PF, et al. Treatment of mild, moderate, and severe onychomycosis using 870- and 930-nm light exposure. J Am Podiatr Med Assoc. 2010;100(3):166-177.
• 18. Lim EH, Kim HR, Park YO, et al. Toenail onychomycosis treated with a fractional carbon-dioxide laser and topical antifungal cream. J Am Acad Dermatol. 2014;70(5):918-923.
• 19. Waibel J, Wulkan AJ, Rudnick A. Prospective efficacy and safety evaluation of laser treatments with real-time temperature feedback for fungal onychomycosis. J Drugs Dermatol. 2013;12(11):1237-1242.
• 20. Kalokasidis K, Onder M, Trakatelli MG, Richert B, Fritz K. The Effect of Q-Switched Nd:YAG 1064 nm/532 nm Laser in the Treatment of Onychomycosis In Vivo. Dermatol Res Pract. 2013;2013:379725.
• 21. Bhatta AK, Keyal U, Huang X, Zhao JJ. Fractional carbon-dioxide (CO2) laser-assisted topical therapy for the treatment of onychomycosis. J Am Acad Dermatol. 2016;74(5):916-923