| Onychomycosis is a chronic infection of nail caused by dermatophytes,nondermatophyte moulds(NDMs)and yeasts.Typically,it manifests as discoloration of the nail,nail plate thickening,brittleness and subungual accumulation of scale.Not only does it affect the aesthetics,but in severe cases it can also destroy the function of normal finger(toe)nails,interfere with daily activities,and negatively affect the quality of life and mental health of patients.The infectd nails may serve as a fungal reservoir which facilitate their transmission to other areas of the body and even to other people.Therefore,the treatment of onychomycosis should be early and thorough.As a local treatment,laser treatment has many advantages,such as low adverse effects,safety and effectiveness,and has become one of the new attempts to treat onychomycosis.Previous studies have shown that either the ultra-pulsed CO2 lattice laser or the long-pulsed 1064 nm Nd:YAG laser alone can be effective for the treatment of onychomycosis,but the results are unsatisfactory.The combination of these two lasers has not been reported for the treatment of onychomycosis.In this study,the clinical efficacy and safety of combining the ultra-pulsed CO2 lattice laser and the the long-pulsed 1064 nm Nd:YAG laser in the treatment of onychomycosis were investigated.PurposeIn this study,we aimed to evaluate the efficacy and safety of ultra-pulsed CO2 lattice laser in combination with long-pulsed 1064 nm Nd:YAG laser for the treatment of onychomycosis.MethodClinical patients of onychomycosis with typical clinical presentationand direct fungal microscopy with positive results were enrolled.All the patients were given ultrapulsed CO2 lattice laser(Parameters:Deep mode;double pulse;frequency 1.0 s;spot 4.0～10.0 mm;energy 15～30 mJ;density 5%)combined with long-pulsed 1064 nm Nd:YAG laser(Parameters:Pulse width 45 ms;spot 6 mm;energy 40-90 J/cm2)treatment for six sessions,treatment interval is 2 weeks.Clinical efficacy assessment and mycological examination were performed before treatment and after treatment onemonth follow-up,and 3-month follow-up.According to age and clinical type grouping to observe the efficacy and adverse effects,and to compare the differences in clinical efficacy and mycological efficacy among different groups.And during the treatment,all the side effects of combined laser treatment were recorded.Result26 patients with 86 target nails were included in research,Compared with before treatment,there were statistically significant(P<0.05)either SCIO and OSI scores at the 1-month follow-up and 3-month follow-up.At the 1-month follow-up and 3-month follow-up,the clinical efficiency rate were 51.2%and 66.3%,the mycologyical clearance rates were 30.2%and 52.3%,both of which showed an increasing trend(P<0.05).All had tolerable transient burning or pain sensation during treatment,and 6 nails(6.97%)had partial anterior nail plate defects during treatment and follow-up,and no other serious adverse effects were observed.At the 1-month follow-up and 3-month follow-up,the mycological clearance rate was higher in group Ⅰ(<40 years)than in group Ⅱ(≥40 years)(P<0.05),but there was no statistical difference in the total clinical efficiency between the two groups(P>0.05).At the 1-month follow-up and 3-month follow-up,the total clinical efficiency rate was significantly higher in the superficial white onychomycosis(SWO)than distal and lateral subungual onychomycosis(DLSO)and total dystrophic onychomycosis(TDO)(P<0.05).At the 1-month follow-up,the fungal clearance rate was higher in the SWO and DLSO than TDO(P<0.05).At the 1-month follow-up and 3-month follow-up,the total clinical efficiency and fungal clearance rates were higher in the non-plaque streaked nail than in the plaque streaked nail(P<0.05).ConclusionUltra-pulsed CO2 lattice laser combined with long-pulsed 1064 nm Nd:YAG laser is a safe and effective method for the treatment of onychomycosis,especially for nonplaque streaked nail and the SWO and DLSO onychomycosis. |
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