Does Laser Work for Treating Onychomycosis? Maybe, Sometimes

Murad Alam, MD, MSCI

A new approach to resolving this difficult-to-treat condition

Two new studies examine different laser approaches to treating onychomycotic nails.

Hollmig and colleagues enrolled 27 patients with a total of 125 nails needing treatment to evaluate the effectiveness of 1064-nm Nd:YAG laser for mycologic cure and clinical improvement (defined as proximal nail-plate clearance). Patients randomized to treatment received two laser treatments, 2 weeks apart. Among the 22 study completers, treatment recipients and untreated control patients had no statistically significant differences in mycologic cure (33% and 20%, respectively) or nail-plate clearance (mean, 0.44 mm and 0.15 mm, respectively).

In another recent trial, Lim and colleagues used fractional CO2 laser to treat onychomycotic nails in 24 patients who had failed to respond to or could not tolerate oral agents. Following laser therapy, patients self-treated with daily topical amorolfine. After 3 monthly treatments, 50% of patients had mycologic cure and 92% had clinical response. Treated nails were on average 2.27 mm thick. Nails thinner than 2.2 mm were significantly more likely to achieve complete clinical and mycologic response (75% vs. 0%). Superficial white onychomycosis was also significantly more responsive.

Citation(s):

Hollmig ST et al. 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 May 15; 70:911.

Lim E-H et al. Toenail onychomycosis treated with a fractional carbon-dioxide laser and topical antifungal cream. J Am Acad Dermatol 2014 May 15; 70:918.