Fractional carbon dioxide laser and topical tioconazole in the treatment of fingernail onychomycosis.

El-Tatawy, Rania Ahmed; Aliweh, Heba Ahmed; Hegab, Doaa Salah; Talaat, Raghda Ahmed Zaki; Shams Eldeen, Maii Atef

Onychomycosis is a common chronic-resistant nail disease. Traditional treatment has its limitations and side effects. This study aimed to evaluate the role of fractional CO2 laser and topical tioconazole 28% nail lacquer in the treatment of fingernail onychomycosis, as sole treatment modalities and in combination. Thirty patients with culture-proven onychomycosis were included and randomly divided into three equal groups. Laser group received six fractional carbon dioxide (CO2) laser sessions at monthly intervals; topical group received topical tioconazole 28% nail lacquer twice daily for 6 months, and combined group received six fractional CO2 laser sessions at monthly intervals with topical tioconazole twice daily for 6 months. Treatment outcome was evaluated through physician's evaluation of improvement using onychomycosis severity index score (OSI), patients' satisfaction, side effect evaluation, and mycological culture (assessed after the end of treatment). At the end of treatment, both laser and combined groups showed significantly better degrees of improvement (P = 0.036, 0.024, respectively) and patient's satisfaction (P = 0.046, 0.003, respectively) in comparison with topical group. Mycological clearance in fungal cultures was significantly higher in combined group than topical group after the end of treatment (P = 0.007). Fractional CO2 laser is a safe and effective treatment modality for onychomycosis. Its efficacy approximates that of fractional CO2 laser combined with topical tioconazole 28% nail lacquer and surpasses that of topical tioconazole 28% monotherapy. It is expected to be an excellent choice for patients in whom systemic antifungals are contraindicated or who are unresponsive or intolerant to topical antifungals.

CARBON dioxide lasers; TIOCONAZOLE; ONYCHOMYCOSIS; NAIL diseases; ANTIFUNGAL agents; LASER therapy; COMBINED modality therapy; IMIDAZOLES; LASERS; PATIENT satisfaction; CUTANEOUS therapeutics; TREATMENT effectiveness; PHARMACODYNAMICS

Lasers in Medical Science, 2019, Vol 34, Issue 9, p1873

0268-8921

Academic Journal

10.1007/s10103-019-02789-2