Treatment of toe nail fungus infection using an AO Q-switched eye-safe erbium glass laser at 1534nm

Myers, Michael J.; Myers, Jeffrey A.; Roth, Franziska; Guo, Baoping; Hardy, Christopher R.; Myers, S.A.; Carrabba, Angelo; Trywick, Carmen; Bryant, Stewart A.; Griswold, John; Mazzochi, Aggie

doi:10.1117/12.2000557

Cited by 5 publications

(5 citation statements)

References 18 publications

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“…The efficiency of such treatment is limited since the nail plate is an effective barrier for the delivery of local pharmaceuticals to the nail bed affected by the fungus [4,5]. Laser radiation can also be used for the treatment of onychomycosis [6‐9].…”

Section: Introductionmentioning

confidence: 99%

Investigation of the Dual‐Stage Method of Active Er:YLF Laser Drug Delivery Through the Nail and Laser‐Induced Transformations of the Drug Extinction Spectrum

2021

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Background and Objective A novel dual‐stage method for active laser drug delivery (DSLADD) in the treatment of nail diseases is being presented. This method includes sequentially performed microporation of the nail with submillisecond pulses of Er:YLF laser radiation through a layer of an aqueous solution of drug deposited on the nail surface (Stage 1) and exposure this layer to the same laser radiation to deliver drug under the nail plate (Stage 2). The delivery of methylene blue (MB) as one of the possible drugs in the treatment of nail diseases is investigated. The influence of the thickness of the MB layer, as well as the energy and number of applied laser pulses, on the rate of active laser delivery is discussed. To illustrate the possible effect of delivery on the drug delivered, special attention is paid to the deformation of the extinction spectrum of MB solution after laser irradiation. Study Design/Materials and Methods Diode‐pumped Er:YLF laser was used for DSLADD. The process of DSLADD under the nail plate was investigated using digital video microscopy. For different values of the thickness of MB solution layer applied to the nail plate and the energy of laser pulses, the number of laser pulses required to create a single through a microchannel in the nail plate and the number of laser pulses required to deliver the solution to the ventral side of the nail plate after its microporation were registered. The mass and the dose of MB solution penetrated under the nail plate, and the rate of MB solution delivery through a single microchannel was determined. Investigation of the influence of Er:YLF laser radiation parameters on the extinction spectrum of the drug was performed using a fiber spectrometer. The extinction spectra of the 0.001% aqueous solution of MB were recorded before and after exposure to a different number of Er:YLF laser pulses with the energy of 1–4 mJ. Results It was found that the minimum number of laser pulses required for active Er:YLF laser drug delivery under the nail corresponds to the MB layer thickness of 100 μm and the laser pulse energy of 4 mJ. It is shown that in this case, the rate of active laser delivery of MB solution reaches 0.26 ± 0.03 mg/pulse. The radiation of the Er:YLF laser affects the shape of the extinction spectrum of the aqueous solution of MВ, which is associated with the transition of the dye from the monomeric to dimeric state. Depending on the laser pulse energy, the fraction of a certain conformational state in the aqueous MB solution can decrease or increase, stimulating a possible change in its photodynamic and antiseptic activity. Conclusion For the first time, a novel DSLADD through the nail has been described and investigated in vitro. It was demonstrated that at Er:YLF laser pulse repetition rate of f = 30 Hz, microporation of the nail plate and drug delivery through a single microchannel will be about 1.5 s. Lasers Surg. Med. © 2021 Wiley Periodicals LLC

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Section: Introductionmentioning

confidence: 99%

Investigation of the Dual‐Stage Method of Active Er:YLF Laser Drug Delivery Through the Nail and Laser‐Induced Transformations of the Drug Extinction Spectrum

2021

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“…There was also one report that used a yeast fungus viability kit as means for testing the effectiveness of laser irradiation . We believe that this method could be useful in illustrating the direct fungicidal effects of laser therapy.…”

Section: Resultsmentioning

confidence: 98%

“…There was also one report that used a yeast fungus viability kit as means for testing the effectiveness of laser irradiation. 14…”

Section: Trial Design and Participantsmentioning

confidence: 99%

Laser therapies for onychomycosis – critical evaluation of methods and effectiveness

Francuzik

Fritz

Sălăvăstru

2016

Acad Dermatol Venereol

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The number of medical devices designed specifically to treat onychomycosis has recently increased, although their mechanism of action is not clear. We evaluated available laser therapies for onychomycosis by reviewing the existing literature. Twenty-two reports, published in peer-reviewed journals and as white papers out of 926 initial search results conveyed enough details to be included in this study. In most cases, the methodology of the trials described in the papers we reviewed was not comprehensive and the reporting of outcomes was not unified. We therefore found it hard to compare different clinical trials to one another. The majority of studies (81.82%) reported using an Nd:YAG laser device to treat onychomycosis. A total of 47.37% of the studies which used a 1064 device (and 47.83% of all studies we reviewed) reported that all treated patients responded positively to laser therapy. A total of 60% of studies reported achieving a complete cure (no clinical symptoms, nor negative mycology) in at least 50% of the treated patients. A low number of adverse events and their mild intensity were consistently reported across all studies, which makes this form of therapy particularly attractive to patients with contraindications for receiving systemic antifungal medication. In order to achieve more unified, comparable studies in the future, we suggest that researchers report a minimum set of outcome measurements: the calculation of the infected nail area pre- and posttreatment, as well as the number of patients achieving mycological, clinical and complete cures.

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“…Myers et al [35] Self-control study and hyperkeratosis of affected nails, side effects of the systemic treatment options, and difficulty in adherence to treatment due to prolonged treatment regimens. [39] As angiogenesis is the main pathology in nail psoriasis, most studies on lasers for nail psoriasis have evaluated the use of pulsed dye laser (PDL).…”

Section: Parameters Used Study Endpointmentioning

confidence: 99%

“…[34] In a study by Myers et al, 12 patients were successfully treated with a long-pulsed erbium glass 1534 nm laser. [35] Zhang et al studied the effect of combination of fractional 2940 nm Er:YAG laser with 5% amorolfine lacquer in onychomycosis.…”

Section: Parameters Used Study Endpointmentioning

confidence: 99%

Evolving role of lasers in nail therapeutics

Dhawan

Sharma²

2022

CSDM

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The diseases of nails are chronic disorders due to the slow rate of growth of nails. The slow rate of nail growth results in long treatment regimens, thus having the potential of causing side effects and posing a limitation of administration to many people. Patients who suffer from organ dysfunction, elderly patients, patients under polypharmacy, and the inability of many patients to adhere to the complete regimen can cause the treatment of nail diseases to be frustrating for both the treating dermatologists as well as patients. Most nail disorders have formed a set treatment protocol for the administration of oral and topical drugs over the years. The use of lasers has yet to make its mark in the treatment of nail diseases due to lack of a universally accepted protocol. This review article looks into various studies evaluating the efficacy of lasers in nail diseases. Largely, this review is based on an evaluation of the effectiveness of lasers in onychomycosis (22 studies and 1 meta-analysis) and nail psoriasis (seven studies). While there is sufficient proof that lasers are effective in the treatment of nails, there is no gold standard for the type of lasers to be used for a particular disease, the treatment parameters, and the follow-up protocol. Evaluation of larger sample sizes against a control group and longer follow-ups are the need of the hour for the formulation of much-needed protocols.

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Treatment of toe nail fungus infection using an AO Q-switched eye-safe erbium glass laser at 1534nm

Cited by 5 publications

References 18 publications

Investigation of the Dual‐Stage Method of Active Er:YLF Laser Drug Delivery Through the Nail and Laser‐Induced Transformations of the Drug Extinction Spectrum

Investigation of the Dual‐Stage Method of Active Er:YLF Laser Drug Delivery Through the Nail and Laser‐Induced Transformations of the Drug Extinction Spectrum

Laser therapies for onychomycosis – critical evaluation of methods and effectiveness

Evolving role of lasers in nail therapeutics

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