title: Treating onychomycoses of the toenail: clinical efficacy of the sub-millisecond 1,064 nm Nd: YAG laser using a 5 mm spot diameter.
abstract: BACKGROUND
  Onychomycosis is a relatively common fungal infection. Current treatments have limited applicability and low cure rates. Recently introduced laser therapy has shown to be a safe and effective treatment for onychomycosis. In this study, we evaluate a submillisecond Nd:YAG 1,064 nm laser for treating onychomycoses of the tonail.
  
  
  METHODS
  Thirteen subjects (9 female, 4 male) with 37 affected toenails received 1 to 3 treatments 4 and/or 8 weeks apart with a sub-millisecond 1,064 nm Nd:YAG laser. Diagnosis of onychomycosis was confirmed with microscopy. Average follow-up time was 16 weeks post-final treatment. Photos were taken and degree of turbidity was determined using a turbidity scale (ranging from "0 = clear nail" to "10 = completely turbid nail") at each visit. Improvement in turbidity was determined by comparison of turbidity scores at baseline and 16-week follow-up on average. Efficacy was assessed by an overall improvement scale (0 to 4), which combined improvement in turbidity scores and microscopic examination. Overall improvement was classified as "4 = complete clearance" if the turbidity score indicated "0 = clear nail" accompanied by a negative microscopic result. No microscopic examination was performed unless the turbidity score showed "0 = clear nail."
  
  
  RESULTS
  Treatments were well tolerated by all subjects and there were no adverse events. Of the 37 toenails treated, 30 (81%) had "moderate" to "complete" clearance average of 16 weeks post-final treatment. Nineteen toenails (51%) were completely clear and all tested negative for fungal infection on direct microscopic analysis. Seven (19%) toenails had significant clearance and four (11%) had moderate clearance.
  
  
  CONCLUSIONS
  The preliminary results of this study show this treatment modality is safe and effective for the treatment of onychomycosis in the short term. Additional studies are needed to more fully assess the clinical and mycological benefits as well as optimize the treatment protocol and parameters.
authors.affiliation: Department of Dermatology, Juntendo University Urayasu Hospital, Japan.
authors.forename: Utako
authors.initials: U
authors.lastname: Kimura
authors.forename: Kaori
authors.initials: K
authors.lastname: Takeuchi
authors.forename: Ayako
authors.initials: A
authors.lastname: Kinoshita
authors.forename: Kenji
authors.initials: K
authors.lastname: Takamori
authors.forename: Masataro
authors.initials: M
authors.lastname: Hiruma
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Suga
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005533:Foot Dermatoses / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D053844:Lasers, Solid-State / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D014009:Onychomycosis / Q000175:diagnosis / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome