Efficacy of laser therapy combined with topical antifungal agents for onychomycosis: a systematic review and meta-analysis of randomised controlled trials

Zhang, Jianfeng; Lin, Peng; Li, Junchen; Guo, Chenqi; Zhai, Jing; Zhang, Yu

doi:10.1007/s10103-022-03561-9

Cited by 10 publications

(4 citation statements)

References 38 publications

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“…Another current development in the research is to delve into the applications of blue light as an antimicrobial. It has been described that bacteria (Gram-positive, Gram-negative, mycobacteria), fungi (yeasts and filamentous fungi), viruses (DNA and RNA), and parasites can be effectively destroyed by light [165,166]. Furthermore, antimicrobial efficacy appears not to be affected by microbe resistance to antibiotics, nor does it lead to resistant microbes after repeated sublethal light applications [167].…”

Section: Radiation Dermatitismentioning

confidence: 99%

Unlocking the Power of Light on the Skin: A Comprehensive Review on Photobiomodulation

Hernández-Bule,

Naharro-Rodríguez,

Bacci

et al. 2024

IJMS

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Photobiomodulation (PBM) is a procedure that uses light to modulate cellular functions and biological processes. Over the past decades, PBM has gained considerable attention for its potential in various medical applications due to its non-invasive nature and minimal side effects. We conducted a narrative review including articles about photobiomodulation, LED light therapy or low-level laser therapy and their applications on dermatology published over the last 6 years, encompassing research studies, clinical trials, and technological developments. This review highlights the mechanisms of action underlying PBM, including the interaction with cellular chromophores and the activation of intracellular signaling pathways. The evidence from clinical trials and experimental studies to evaluate the efficacy of PBM in clinical practice is summarized with a special emphasis on dermatology. Furthermore, advancements in PBM technology, such as novel light sources and treatment protocols, are discussed in the context of optimizing therapeutic outcomes and improving patient care. This narrative review underscores the promising role of PBM as a non-invasive therapeutic approach with broad clinical applicability. Despite the need for further research to develop standard protocols, PBM holds great potential for addressing a wide range of medical conditions and enhancing patient outcomes in modern healthcare practice.

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Section: Radiation Dermatitismentioning

confidence: 99%

Unlocking the Power of Light on the Skin: A Comprehensive Review on Photobiomodulation

Hernández-Bule,

Naharro-Rodríguez,

Bacci

et al. 2024

IJMS

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“…Laser-assisted drug delivery (LADD) treatment has been considered as novel safe and efficient modality in the context of onychomycosis management where fungal eradication may be mediated via disturbance of fungi and spores by the thermal action of laser therapy (4) . Different laser approaches are tried for cases of resistant onychomycosis with variable results including CO2 and Nd:YAG lasers (5,6) . This study was conducted to compare between two methods of treatment in the same patient with fingernails onychomycosis; the first was the fractional CO2 laser (FCO2L) plus topical tioconazole 28% nail solution and the second was only topical tioconazole 28% solution.…”

Section: Introductionmentioning

confidence: 99%

Fractional CO2 Laser Plus Topical Tioconazole 28% versus Topical Tioconazole 28% Alone in the Treatment of Onychomycosis

2024

The Egyptian Journal of Hospital Medicine

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Background: Onychomycosis is a chronic fungal infection of the nail unit. The therapeutic options include oral antifungals as terbinafine, pulse itraconazole, fluconazole and voriconazole. Various laser systems have been tried for resistant cases to improve the results of treatment as carbon dioxide (CO2) and Nd:YAG lasers. Objective: Compare between two treatment methods; combined therapy of fractional CO2 laser (FCO2L) plus topical tioconazole 28% nail solution versus topical tioconazole 28% nail solution alone in the same patient with fingernails onychomycosis. Methods: This was prospective comparative interventional study conducted on 20 patients with two or more affected fingernails. The degree of affection of the studied nails was assessed clinically by onychomycosis severity index (OSI) and was confirmed by KOH and mycological culture. The studied nails were categorized into two corresponding groups; group (A), fingernails were treated with combined therapy in the form of 4-6 fractional CO2 laser sessions four weeks apart plus topical tioconazole 28% twice daily for six months, group (B), fingernails were treated with topical tioconazole 28% alone twice daily for six months. Results: A high statistically significant improvement was reported among patients treated with combined therapy than those who treated with antifungal only. The CO2 laser plus topical tioconazole solution yielded significantly higher percentage of improvement for onychomycosis. Conclusion: Both combined therapy and local therapy reported safe and promising outcomes. However combined therapy was associated with better improvement and local therapy was associated with minimal adverse events.

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“…3 Various laser/light-based devices have been introduced as complementary or alternative treatment modalities for dermatophytosis, particularly for finger or toenail onychomycosis, since carbon dioxide (CO 2 ) lasers were used for treating infectious toenail disorders. [4][5][6][7][8][9][10] These devices include long-pulsed 1064-nm neodymium (Nd):yttrium-aluminum-garnet (YAG) laser, Q-switched 532-nm and 1064-nm Nd:YAG laser, fractional CO 2 laser, 870-nm and 930-nm near-infrared dualband diode laser, 1444-nm Nd:YAG laser, 1319-nm diode laser, infrared broadband system, and 405-/635-nm dual-band diode laser. [4][5][6][7][8][9][10][11][12] Studies have demonstrated the action mechanisms of energy-based antifungal treatments: fungal chromophores in the cell membranes absorb irradiated energy sources to generate thermomechanical reaction that destroys cell walls and induces cellular apoptosis or necrosis of pathogens.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6][7][8][9][10] These devices include long-pulsed 1064-nm neodymium (Nd):yttrium-aluminum-garnet (YAG) laser, Q-switched 532-nm and 1064-nm Nd:YAG laser, fractional CO 2 laser, 870-nm and 930-nm near-infrared dualband diode laser, 1444-nm Nd:YAG laser, 1319-nm diode laser, infrared broadband system, and 405-/635-nm dual-band diode laser. [4][5][6][7][8][9][10][11][12] Studies have demonstrated the action mechanisms of energy-based antifungal treatments: fungal chromophores in the cell membranes absorb irradiated energy sources to generate thermomechanical reaction that destroys cell walls and induces cellular apoptosis or necrosis of pathogens. 13,14 Moreover, they have shown that laser/light-based treatments generated increased production of mitochondrial reactive oxygen species that induced apoptotic pathways of fungi.…”

Section: Introductionmentioning

confidence: 99%

In vivo Guinea Pig Model Study for Evaluating Antifungal Effect of a Dual-Diode Laser with Wavelengths of 405 Nm and 635 Nm on Dermatophytosis

Ahn¹,

Mo²,

Choi³

et al. 2023

CCID

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Background: Various laser-and light-based devices have been introduced as complementary or alternative treatment modalities for dermatophytosis, particularly for finger or toenail onychomycosis.Objective: This study aimed to comparatively evaluate the antifungal effects of 405-nm and 635-nm dual-band diode lasers using an in vivo guinea pig model of dermatophytosis. Materials and Methods: A guinea pig model was developed by the repetitive application of fungal spore preparations to the back skin of guinea pigs. Dual-diode laser treatment was delivered to the guinea pig skin at a power of 24 mW at a wavelength of 405 nm and 18 mW at 635 nm for 12 min. The treatments were administered three times weekly for 2 weeks, and a mycological study was performed. Results: Mycological studies using scraped samples obtained from treatment groups A (N = 8) and B (N = 8) after dual-diode laser treatment revealed that seven of eight (87.5%) samples in each group had negative results for direct potassium hydroxide microscopy and fungal culture studies. Skin specimens from each infected laser-untreated guinea pig exhibited spongiotic psoriasiform epidermis with parakeratosis. Meanwhile, skin specimens from infected laser-treated guinea pigs in groups A and B demonstrated thinner epidermal thickness than those from infected untreated controls but thicker than those from uninfected treated controls without noticeable inflammatory cell infiltration in the dermis. Conclusion:The guinea pig dermatophytosis model can be used to comparatively evaluate the efficacy and safety of various treatment modalities, including dual-diode lasers, for superficial fungal skin infection.

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Efficacy of laser therapy combined with topical antifungal agents for onychomycosis: a systematic review and meta-analysis of randomised controlled trials

Cited by 10 publications

References 38 publications

Unlocking the Power of Light on the Skin: A Comprehensive Review on Photobiomodulation

Unlocking the Power of Light on the Skin: A Comprehensive Review on Photobiomodulation

Fractional CO2 Laser Plus Topical Tioconazole 28% versus Topical Tioconazole 28% Alone in the Treatment of Onychomycosis

In vivo Guinea Pig Model Study for Evaluating Antifungal Effect of a Dual-Diode Laser with Wavelengths of 405 Nm and 635 Nm on Dermatophytosis

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