Domenico Piccolo, MD,1 Dimitra Kostaki, MD,2 Ester Del Duca, MD,3 Giovanni Cannarozzo, MD,4 Mario Sannino, MD,4 and Steven Nistico’ , MD5
1Italian Association Outpatient Dermatologists, Pescara, Italy.
2Skin Center Dermo-Aesthetic Lasers Centres, Pescara, Italy.
3Division of Dermatology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
4Lasers in Dermatology, University of Rome Tor Vergata, Rome, Italy.
5Department of Health Sciences, University of Catanzaro, Catanzaro, Italy.

Abstract Objective: The aim of this study is to evaluate the efficacy of long-pulsed 1064-nm Nd:YAG laser in penetrating tissue and targeting the fungal overgrowth in the nail plate.

Background: Onychomycosis is the most frequent nail disorder. Current treatments include oral and topical antifungal agents, photodynamic therapy, and surgical approaches such as mechanical, chemical, or surgical nail avulsion. Moreover, the use of lasers to treat nail diseases has been approved in the United States by the Food and Drug Administration (FDA). Wide literature has been produced to assess the effectiveness of these devices, but, because the opposing results emerging from current studies, more data are still needed on the long-lasting efficacy and safety of this procedure.

Methods: Twenty consecutive, unselected patients were enrolled in the study and treated, at intervals of 1 week, for a total of four sessions, using a long-pulsed 1064-nm Nd:YAG laser. In each session, three passages across each nail plate were performed with 1-min pause between each passage. A special lens for dermatoscopy, connected to a digital camera, was used for dermoscopic images.

Results: In fourteen patients (70%; 12F; 3M), excellent results were obtained with an important reduction of chromonychia, onycholysis, opacity, longitudinal striae, and jagged proximal edge. Better results were observed in severe cases in the 2-month follow-up visit.

Conclusions: Data for treating nail onychomycosis with laser and light therapy seem to be positive. The promising results of our study identify long-pulsed 1064-nm Nd:YAG laser as a possible alternative option for the treatment of onychomycosis. However, increasing subject data, improving study methodology, and output parameters may become an important next step of study in the treatment of nail onychomycosis.

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