title: Treatment of onychomycosis using a submillisecond 1064-nm neodymium:yttrium-aluminum-garnet laser.
abstract: BACKGROUND
  Laser treatment has emerged as a novel treatment modality for onychomycosis.
  
  
  OBJECTIVE
  We sought to determine thermal response and optical effects of a submillisecond neodymium:yttrium-aluminum-garnet (Nd:YAG) 1064-nm laser on common fungal nail pathogens, and the clinical efficacy and safety of the Nd:YAG 1064-nm laser on onychomycotic toenails.
  
  
  METHODS
  A 4-part in vitro and in vivo study was conducted using a Nd:YAG 1064-nm laser. The first portion evaluated 3 different nail pathogens in suspension at 7 heat and time exposures. The second and third parts of the study irradiated pure fungal colonies. The final portion involved an in vivo treatment of toenails over 5 treatment sessions.
  
  
  RESULTS
  A fungicidal effect for Trichophyton rubrum was seen at 50°C after 15 minutes, and for Epidermophyton floccosum at 50°C after 10 minutes. Limited growth of Scytalidium was seen at 55°C after 5 minutes. No inhibition was observed after laser treatment of fungal colonies or suspensions. In vivo treatment of toenails showed no improvement in Onychomycosis Severity Index score.
  
  
  CONCLUSIONS
  The Nd:YAG 1064-nm laser was the only laser tested.
  
  
  CONCLUSIONS
  Laser treatment of onychomycosis was not related to thermal damage or direct laser effects. In vivo treatment did not result in onychomycosis cure.
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Carney
authors.forename: Wendy
authors.initials: W
authors.lastname: Cantrell
authors.forename: Judy
authors.initials: J
authors.lastname: Warner
authors.forename: Boni
authors.initials: B
authors.lastname: Elewski
mesh_terms: D000328:Adult; D000368:Aged; D000535:Aluminum / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D066298:In Vitro Techniques; D053844:Lasers, Solid-State / Q000627:therapeutic use; D028022:Low-Level Light Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009354:Neodymium / Q000627:therapeutic use*; D014009:Onychomycosis / Q000175:diagnosis / Q000532:radiotherapy*; D010865:Pilot Projects; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014249:Trichophyton / Q000528:radiation effects*; D055815:Young Adult; D015019:Yttrium / Q000627:therapeutic use*
chemical_list: C503779:yttrium-aluminum-garnet; D009354:Neodymium; D015019:Yttrium; D000535:Aluminum
keywords: CFU; Nd:YAG; OSI; Onychomycosis Severity Index; colony-forming unit; fungal; irradiation; laser; neodymium:yttrium-aluminum-garnet; onychomycosis; thermal