title: Real-World Efficacy of 1064-nm Nd:YAG Laser for the Treatment of Onychomycosis.
abstract: BACKGROUND
  Onychomycosis is a cosmetic and, at times, medical concern; therefore, effective and safe alternatives to treatment are needed.
  
  
  OBJECTIVE
  To determine the efficacy of a 1064-nm Nd:YAG laser for the treatment of onychomycosis in a real-world setting.
  
  
  METHODS
  A single-centre retrospective chart review was conducted between 2012 and 2013. One hundred consecutive patients with a culture- and/or potassium hydroxide-confirmed diagnosis of onychomycosis were treated at least twice. Baseline and follow-up photographs were taken, and the change in degree of clinical nail involvement of the subject's great toenail was determined by a blinded reviewer using validated planimetry measurement.
  
  
  RESULTS
  A total of 199 hallux nails from 100 subjects were assessed. The mean infected area decreased from 53.2% at baseline to 50.8% at the end of the study (paired t test, P = .054; Wilcoxon signed rank test, P = .006). Degree of nail involvement was statistically significantly associated with amount of improvement; subjects who had the greatest degree of nail involvement improved the most, while those with less severe disease showed a worsening of nail appearance (Kruskal-Wallis test, P < .001). Three-quarters (72.6%) of nails that had more than 67% nail involvement showed statistically significant improvement (χ2test, P = .001). Adverse events were limited to mild to moderate pain at the time of therapy. A total of 76 subjects were assessed for treatment satisfaction: 60% were very satisfied with treatment despite limited clinical improvement in some cases.
  
  
  CONCLUSIONS
  Laser therapy has a very limited positive clinical effect on the appearance of onychomycosis after 2 treatment sessions.
authors.affiliation: 1 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.|2 Pacific Dermaesthetics, Vancouver, BC, Canada.
authors.forename: Jason K
authors.initials: JK
authors.lastname: Rivers
authors.affiliation: 2 Pacific Dermaesthetics, Vancouver, BC, Canada.
authors.forename: Brianne J
authors.initials: BJ
authors.lastname: Vestvik
authors.affiliation: 3 University of British Columbia, Vancouver, BC, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Berkowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006214:Hallux; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D014009:Onychomycosis / Q000532:radiotherapy*; D010781:Photography; D012189:Retrospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome; D055815:Young Adult
keywords: clinical experience; laser; onychomycosis