title: Fractional carbon-dioxide (CO2) laser-assisted topical therapy for the treatment of onychomycosis.
abstract: BACKGROUND
  Inability of topical medications to penetrate via nail plate brings a great challenge to clinicians in treating onychomycosis. Furthermore, oral medications are not appropriate for all patients because of drug interactions, adverse effects, and contraindications.
  
  
  OBJECTIVE
  We sought to evaluate the clinical efficacy of fractional carbon-dioxide laser-assisted topical therapy for onychomycosis.
  
  
  METHODS
  In total, 75 patients with 356 onychomycotic nails confirmed by mycologic examination were included in this study. All the affected nails received 3 sessions of laser therapy at 4-week intervals and once-daily application of terbinafine cream for 3 months.
  
  
  RESULTS
  In all, 94.66% and 92% of the treated patients were potassium hydroxide and culture negative, respectively, after 3 months of treatment. However, only 84% and 80% were potassium hydroxide and culture negative, respectively, at 6 months of follow-up. Using Scoring Clinical Index for Onychomycosis electronic calculator, 73.33% of the patients scored higher than 6 and 26.66% of the patients scored 6 or less. Those who scored more than 6 were evaluated clinically and 98.18% of them showed response to treatment at 3 months and 78.18% of them at 6 months of follow-up.
  
  
  CONCLUSIONS
  Lack of control group and short duration of follow-up are limitations.
  
  
  CONCLUSIONS
  Fractional carbon-dioxide laser therapy combined with topical antifungal was found to be effective in the treatment of onychomycosis. However, randomized clinical studies are needed before it can be widely used in clinics.
authors.affiliation: Department of Dermatology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Anil Kumar
authors.initials: AK
authors.lastname: Bhatta
authors.affiliation: Department of Dermatology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Uma
authors.initials: U
authors.lastname: Keyal
authors.affiliation: Department of Dermatology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China. Electronic address: alida_huang@163.com.
authors.forename: Xin
authors.initials: X
authors.lastname: Huang
authors.affiliation: Department of Dermatology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Jing Jun
authors.initials: JJ
authors.lastname: Zhao
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005533:Foot Dermatoses / Q000175:diagnosis / Q000628:therapy*; D006229:Hand Dermatoses / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D054020:Lasers, Gas / Q000627:therapeutic use*; D028022:Low-Level Light Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D014009:Onychomycosis / Q000175:diagnosis / Q000628:therapy*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents
keywords: dermatophytes; fractional laser; onychomycosis; topical therapy