Long term efficacy of Nd: Yag laser treatment for onychomycosis : A debridement option for dermatophytoma.

Onychomycosis is a highly prevalent disease that causes great morbidity. Topical and oral treatment are not always effective and can be associated with side effects. Energy-based devices have been studied as a safe therapeutic tool. 36 cases received 4 to 8 laser treatments with 1 or 2-week-interval. Patients were reevaluated after 1, 3, 6 and 12 months and the Onychomycosis Severity Index (OSI) was calculated each visite. 69,4% showed an improvement in the OSI, with 12 (33.3%) progressing to cure and 13 (36,1%) showing a decrease in the global score. There was a statistically significant reduction in the median OSI over time, especially at 6-month and 12-month assessments (p = 0.022 and p < 0.001, respectively). Five or more treatments were associated to a better outcome (p = 0.001). On the other hand, there was no interference regarding gender, age, presence of more than 1 affected nail or pathogen isolated in culture. A positive outcome was statistically more relevant in patients who were classified as severe before treatment (p = 0.015). Furthermore, cases that presented dermatophytoma had a more favorable outcome, with 78.5% improvement after 12-months follow-up (p = 0.040). All patients tolerated well the sessions even if pain was present and they were all satisfied with their results. No adverse events were detected. Nd: YAG laser can effectively treat onychomycosis and the outcome is even better in cases that present with dermatophytoma, suggesting that this laser could be used as a form of debridement, increasing cure rates, especially when associated with systemic medication.