The Effect of Q-Switched Nd:YAG 1064？nm/532？nm Laser in the Treatment of Onychomycosis In Vivo

In this prospective clinical study, the Q-Switched Nd:YAG 1064？nm/532？nm laser (Light Age, Inc., Somerset, NJ, USA) was used on 131 onychomycosis subjects (94 females, 37 males; ages 18 to 68 years). Mycotic cultures were taken and fungus types were detected. The laser protocol included two sessions with a one-month interval. Treatment duration was approximately 15 minutes per session and patients were observed over a 3-month time period. Laser fluencies of 14？J/cm2 were applied at 9 billionths of a second pulse duration and at 5？Hz frequency. Follow-up was performed at 3 months with mycological cultures. Before and after digital photographs were taken. Adverse effects were recorded and all participants completed “self-evaluation questionnaires” rating their level of satisfaction. All subjects were well satisfied with the treatments, there were no noticeable side effects, and no significant differences were found treating men versus women. At the 3-month follow-up 95.42% of the patients were laboratory mycologically cured of fungal infection. This clinical study demonstrates that fungal nail infections can be effectively and safely treated with Q-Switched Nd:YAG 1064？nm/532？nm laser. It can also be combined with systemic oral antifungals providing more limited treatment time. 1. Introduction Onychomycosis is defined as a fungal infection of the nail that expands slowly and if left untreated leads to complete destruction of the nail plate. Onychomycosis can be dermatophytic (99%) and/or nondermatophytic (1%) (including yeasts) infections of the nail plate. The dermatophytes Trichophyton rubrum and Trichophyton mentagrophytes are the most common causative pathogens responsible for up to 90% of all cases [1]. Onychomycosis represents about 30% of all dermatophyte infections and accounts for 18%–40% of all nail disorders. The prevalence of onychomycosis ranges between 2% and 28% of the general population and it is estimated to be significantly higher in specific populations such as in diabetes mellitus, the immunosuppressed, and elderly [2, 3]. Among the nondermatophytes, the yeast Candida albicans, Candida tropicalis, aspergillus, and other molds may be responsible. It usually represents contamination and is an emerging problem in HIV patients. Toenails are far more likely to be involved than fingernails. Initially solitary nails are involved; later, many may be infected, but often one or more can stay disease-free. Onychomycosis has no tendency for spontaneous remission and should be considered as a problem with serious medical, social, and emotional