title: Efficacy and safety of 1064-nm Nd:YAG laser in treatment of onychomycosis.
abstract: BACKGROUND
  Onychomycosis is a common nail disease, especially in older patients. Various treatment options are currently available for onychomycosis; however, their limitations include high failure rates, time-consuming nature, high cost and high risk of drug interactions. Previous studies on the treatment of dermatophyte onychomycosis with a long-pulsed 1064-nm Nd:YAG laser demonstrated excellent outcomes without severe side effects.
  
  
  OBJECTIVE
  To evaluate the efficacy and side effects of onychomycosis treatment with a long-pulsed 1064-nm Nd:YAG laser.
  
  
  METHODS
  Sixty-four onychomycotic nails (35 patients) were evaluated. The first treatment cycle involved treatment with a long-pulsed 1064-nm Nd:YAG laser in four sessions at 1-week intervals. A potassium hydroxide examination and fungal culture were performed every week during this treatment course and then at a 1-month follow-up visit. If either test was positive for a pathogenic organism, a second treatment cycle was performed. If the two tests produced negative results, each affected nail was followed up at 3- and 6-month visits after completion of the second treatment protocol. In cases of resistance (positive for a pathogenic organism after completion of the second treatment cycle), the onychomycotic nails were excluded from the study and treated by standard methods.
  
  
  RESULTS
  Of all 64 nails evaluated, 59 completed the first cycle of treatment and 24 (40.7%) demonstrated mycological clearance at the 1-month follow up. Thirty-five of the 59 nails (59.3%) were positive for a pathogenic organism and underwent a second treatment cycle. Upon completion of the second treatment cycle, 28 nails remained enrolled in the study, and the mycological test results were negative in nine of these (31.2%). For all nails that completed the first or second treatment cycle, the overall cure rates at the 1-, 3- and 6-month follow-up visits were 63.5, 57.7 and 51.9%, respectively. Side effects were mild and limited to erythema and swelling after the laser procedure.
  
  
  CONCLUSIONS
  Long-pulsed 1064-nm Nd:YAG laser therapy is safe and effective for the treatment of onychomycosis. However, a larger sample and longer follow-up period are needed to confirm our findings.
authors.affiliation: a Department of Dermatology , Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand.
authors.forename: Rungsima
authors.initials: R
authors.lastname: Wanitphakdeedecha
authors.affiliation: a Department of Dermatology , Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand.
authors.forename: Kanchalit
authors.initials: K
authors.lastname: Thanomkitti
authors.affiliation: a Department of Dermatology , Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand.
authors.forename: Sumanas
authors.initials: S
authors.lastname: Bunyaratavej
authors.affiliation: a Department of Dermatology , Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand.
authors.forename: Woraphong
authors.initials: W
authors.lastname: Manuskiatti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006878:Hydroxides / Q000737:chemistry; D053844:Lasers, Solid-State / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D014009:Onychomycosis / Q000532:radiotherapy*; D017680:Potassium Compounds / Q000737:chemistry; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006878:Hydroxides; D017680:Potassium Compounds; C029943:potassium hydroxide
keywords: Nd:YAG; Onychomycosis; laser