title: Lack of efficacy with 1064-nm neodymium:yttrium-aluminum-garnet laser for the treatment of onychomycosis: a randomized, controlled trial.
abstract: BACKGROUND
  Laser therapies have been Food and Drug Administration approved for temporary nail plate clearance; however, there is minimal evidence of their long-term efficacy.
  
  
  OBJECTIVE
  We sought to evaluate the clinical and mycological clearance of toenails treated with 1064-nm neodymium:yttrium-aluminum-garnet laser versus no treatment.
  
  
  METHODS
  This was a randomized, controlled, single-center trial comparing 2 treatments with 1064-nm neodymium:yttrium-aluminum-garnet laser (fluence of 5 J/cm(2), rate of 6 Hz) spaced 2 weeks apart versus no treatment in 27 patients (N = 125 affected nails) with clinical and mycological diagnosis of onychomycosis. At 3 months, patients were assessed with mycological cultures and proximal nail plate measurements. Patients treated with laser were also assessed with proximal nail plate measurements at 12 months.
  
  
  RESULTS
  At 3 months, 33% of patients treated with laser achieved a negative mycological culture compared with 20% of the control group (P = .49), and had more proximal nail plate clearance compared with control subjects (0.44 vs 0.15 mm, P = .18), which was not statistically significant. At 12 months, there was no difference in nail plate clearance between laser versus control subjects (0.24 vs 0.15 mm, P = .59).
  
  
  CONCLUSIONS
  Our study was limited by the small sample size and number of treatments.
  
  
  CONCLUSIONS
  There was no significant mycological culture or clinical nail plate clearance with 1064-nm neodymium:yttrium-aluminum-garnet laser compared with control.
authors.affiliation: Department of Dermatology, Stanford University Medical Center, Stanford, California. Electronic address: Stanley.hollmig@stanford.edu.
authors.forename: S Tyler
authors.initials: ST
authors.lastname: Hollmig
authors.affiliation: Department of Dermatology, Stanford University Medical Center, Stanford, California.
authors.forename: Zakia
authors.initials: Z
authors.lastname: Rahman
authors.affiliation: Stanford University School of Medicine, Stanford, California.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Henderson
authors.affiliation: Department of Dermatology, Stanford University Medical Center, Stanford, California.
authors.forename: R Maxwell
authors.initials: RM
authors.lastname: Rotatori
authors.affiliation: Berman Gladstone Skin Institute, Walnut Creek, California.
authors.forename: Hayes
authors.initials: H
authors.lastname: Gladstone
authors.affiliation: Department of Dermatology, Stanford University Medical Center, Stanford, California.
authors.forename: Jean Y
authors.initials: JY
authors.lastname: Tang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005533:Foot Dermatoses / Q000601:surgery*; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D014009:Onychomycosis / Q000601:surgery*; D019233:Retreatment; D017211:Treatment Failure; D055815:Young Adult
keywords: 1064-nm neodymium:yttrium-aluminum-garnet laser; onychomycosis