Liu C, et al. - Researchers sought to establish an optimal long-pulsed 1,064-nm neodymium:yttrium-aluminum-garnet laser (LPNYL) treatment regimen for onychomycosis caused by Trichophyton rubrum (OCTr). Findings suggested safety and efficacy of LPNYL for treating OCTr. The main factors that impact the efficacy are energy density and treatment times. For LPNYL, the optimal regimen is an energy density of 45 J/cm², pulse width of 35 ms, spot size of 4 mm, frequency of 1 Hz, and 6 treatments with 1-week intervals. Rapid clinical recovery was demonstrated by laser treatment.

Methods

• First, experts treated the 511 infected nails of 177 patients using LPNYL with orthogonally designed regimens according to various energy densities, spot sizes, pulse widths, and treatment times.
• They established the optimal treatment regimen by multivariate analysis.
• Further, they randomized the 69 patients with 221 infected nails to receive oral itraconazole (drug group) and the optimal regimen of LPNYL treatment (laser group).
• They assessed the clinical efficacy (CE) and mycological efficacy (ME) at 6 and 12 months after the start of treatment, and adverse reactions were recorded in both groups.

Results

• Findings suggested a significant association of both CE and ME with the energy density (p < 0.05) and treatment times (p < 0.05), but not with the spot size (0.071 < p < 0.083) or pulse width (0.051 < p < 0.060), at 6 or 12 months.
• As per data, they did not note any significant differences at 6 or 12 months (p > 0.05), and no significant difference was observed in CE at 12 months between the 2 groups (p > 0.05).
• At 6 months, compared to the drug group, the CE in the laser group was significantly higher (p < 0.001).