Dermatologic surgeryLack of efficacy with 1064-nm neodymium:yttrium-aluminum-garnet laser for the treatment of onychomycosis: A randomized, controlled trial
Section snippets
Methods
The study was a randomized, controlled trial conducted at a single academic institution. The primary end point for the study was the percentage of patients with a negative mycological culture from all clinically involved nails at 3 months, and the secondary end point was the difference in clinical proximal nail plate clearance at 3 months and at 12 months. An additional secondary end point was the number of nails with complete clinical nail plate clearance at 3 months and, for laser patients,
Results
In all, 42 patients were assessed for eligibility (Fig 1). Fifteen patients were excluded because of lack of positive mycological culture. The remaining 27 patients were randomized in a 2:1 ratio into laser (N = 17) and control (N = 10) groups. Five of the patients in the laser group did not return for follow-up, with 12 of patients in this group completing the study, whereas all of the patients in the control group completed the study. The 12 patients in the laser group exhibited 57 clinically
Discussion
We performed a randomized controlled trial of 1064-nm Nd:YAG laser treatment for onychomycosis. We found that 1064-nm Nd:YAG laser treatment did not improve mycological culture or long-term proximal nail plate clearance (Fig 3). Similar to other studies, we detected a trend of improved proximal nail plate clearance at 3 months, but this clearance did not persist at 12 months. Our study supports the recent in vitro findings by Hees et al14 who treated fungal colony isolates in a Petri dish with
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Onychomycosis: Treatment and prevention of recurrence
2019, Journal of the American Academy of DermatologyCitation Excerpt :Penetration of the nail plate and targeting of fungi occurs at wavelengths of 750 to 1300 nm.119 Short, long pulsed, and Q-switched neodymium-doped yttrium aluminum garnet lasers,114,120-128 near infrared and dual wavelength diode lasers,129,130 and fractional CO2 lasers131,132 have been used for the treatment of fungal nail infections with mixed results. It is also difficult to compare clinical trial data between lasers and oral and topical therapies for onychomycosis because of the vastly different endpoints used.
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The JOULE ClearSense handpiece was loaned to Stanford Department of Dermatology from Sciton Inc for the purposes of the study.
Conflicts of interest: None declared.
Reprints not available from the authors.