title: Toenail onychomycosis treated with a fractional carbon-dioxide laser and topical antifungal cream.
abstract: BACKGROUND
  Traditional pharmacotherapy for onychomycosis has low to moderate efficacy and may be associated with adverse reactions and medication interactions limiting its use in many patients.
  
  
  OBJECTIVE
  We evaluated the clinical efficacy and safety of a fractional carbon-dioxide laser with topical antifungal therapy in the treatment of onychomycosis.
  
  
  METHODS
  In all, 24 patients were treated with fractional carbon-dioxide laser therapy and a topical antifungal cream. The laser treatment consisted of 3 sessions at 4-week intervals. Efficacy was assessed based on the response rate from standardized photographs, a microscopic examination of subungual debris, and subjective evaluations.
  
  
  RESULTS
  Among the patients, 92% showed a clinical response and 50% showed a complete response with a negative microscopic result. The factors that influenced a successful outcome were the type of onychomycosis and the thickness of the nail plate before treatment. The treatment regimen was well tolerated and there was no recurrence 3 months after the last treatment episode.
  
  
  CONCLUSIONS
  The study followed up only 24 patients and there were no relevant treatment controls.
  
  
  CONCLUSIONS
  Fractional carbon-dioxide laser therapy, combined with a topical antifungal agent, was effective in the treatment of onychomycosis. It should be considered an alternative therapeutic option in patients for whom systemic antifungal agents are contraindicated.
authors.affiliation: Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea.
authors.forename: Eun-Hwa
authors.initials: EH
authors.lastname: Lim
authors.affiliation: Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea.
authors.forename: Hyeong-rae
authors.initials: HR
authors.lastname: Kim
authors.affiliation: Departments of Statistics, College of Business and Economics, Korea University, Seoul, Korea.
authors.forename: Young-Ok
authors.initials: YO
authors.lastname: Park
authors.affiliation: Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea.
authors.forename: Young
authors.initials: Y
authors.lastname: Lee
authors.affiliation: Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea.
authors.forename: Young-Joon
authors.initials: YJ
authors.lastname: Seo
authors.affiliation: Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea.
authors.forename: Chang-Deok
authors.initials: CD
authors.lastname: Kim
authors.affiliation: Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea.
authors.forename: Jeung-Hoon
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea. Electronic address: im1177@hanmail.net.
authors.forename: Myung
authors.initials: M
authors.lastname: Im
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D054020:Lasers, Gas / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000008:administration & dosage*; D014009:Onychomycosis / Q000188:drug therapy* / Q000601:surgery*; D063465:Skin Cream
chemical_list: D000935:Antifungal Agents; D009025:Morpholines; C038974:amorolfine
keywords: fractional laser; laser therapy; onychomycosis