Swipe om te navigeren naar een ander artikel
The online version of this article (doi:10.1186/1757-1146-7-34) contains supplementary material, which is available to authorized users.
The author declares he has no competing interests.
IB was responsible for the drafting of the paper and conducting the review. All authors read and approved the final manuscript.
Onychomycosis is a common nail pathology which has proven to be a treatment challenge to healthcare professionals. Antifungal drugs have been the mainstay of therapy for many years. Recently, laser technologies have been introduced as a treatment for onychomycosis avoiding the disadvantages of systemic and topical drug therapies, offering a rapid treatment for an often persistent nail condition. The purpose of this study was to review published evidence regarding the effectiveness of laser technologies in the treatment of onychomycosis.
The primary question for this review was “what evidence is there for the use of lasers in the treatment of onychomycosis”? A systematic literature search of published papers indexed on Pubmed and Web of Science® was undertaken in June 2014 for original, published research. The primary outcome measures for efficacy were mycological cure and clearance of the affected nail (clinical cure).
This review returned a total of twelve eligible published studies evaluating the use of lasers in the treatment of onychomycosis. Two were randomised controlled trials, four were comparative design studies (with no placebo/control groups) and the remainder were case series. The level of evidence was generally low level reflecting predominantly small sample size and lack of control groups. The results from studies were conflicting and follow up periods for patients in studies were generally short. Many studies excluded patients with severe or dystrophic onychomycosis.
The evidence pertaining to the effectiveness of laser treatment of onychomycosis is limited and of poor methodological quality. Future studies using a randomised controlled trial designs with larger study populations and clear procedures are required to permit a full evaluation of this emerging technology.
Additional file 2: Levels of evidence for the AOTA Evidence-Based Practice Project [ 23] .(DOCX 12 KB)
Authors’ original file for figure 113047_2014_755_MOESM3_ESM.tif
Borovoy M, Fuller TA, Holtz P, Kaczander BI: Laser surgery in podiatric medicine–present and future. J Foot Surg. 1983, 22: 353-357. PubMed
Rothermel E, Apfelberg DB: Carbon dioxide laser use for certain diseases of the toenails. Clin Podiatr Med Surg. 1987, 4: 809-821. PubMed
Borovoy M, Tracy M: Noninvasive CO 2 laser fenestration improves treatment of onychomycosis. Clin Laser Mon. 1992, 10: 123-124. PubMed
Bristow I, Walker N: Pulsed Dye laser for the treatment of plantar warts - two case studies. Foot. 1997, 7: 229-230. CrossRef
Webster GF, Satur N, Goldman MP, Halmi B, Greenbaum S: Treatment of recalcitrant warts using the pulsed dye laser. Cutis. 1995, 56: 230-232. PubMed
Dow H: New laser treatment for onychomycosis. Podiatry Now. 2009, 12: 46-
Bristow I, De Berker D: The use of lasers in the treatment of onychomycosis (letter). Podiatry Now. 2009, 12: 57-
Elewski B, Tavakkol A: Safety and tolerability of oral antifungal agents in the treatment of fungal nail disease: a proven reality. Ther Clinical Risk Manag. 2005, 1: 299-306.
APBI Compendium of Medicines: Summary of product characteristics for Lamisil Tablets 250mg. http://www.medicines.org.uk/emc/medicine/1290#CONTRAINDICATIONS,
Nenoff P, Grunewald S, Paasch U: Laser therapy of onychomycosis. J Dtsch Dermatol Ges. 2014, 12: 33-38. PubMed
Ortiz AE, Avram MM, Wanner MA: A review of lasers and light for the treatment of onychomycosis. Lasers Surg Med. 2013, Online ahead of publication
Moher D, Liberati A, Tetzlaff J, Altman DG: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. http://www.prisma-statement.org/2.1.2%20-%20PRISMA%202009%20Checklist.pdf,
NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. http://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/stage_2_consultation_levels_and_grades.pdf,
Hees H, Jäger MW, Raulin C: Treatment of onychomycosis using the 1064 nm Nd:YAG laser: a clinical pilot study. J Dtsch Dermatol Ges. 2014, 12: 322-329. PubMed
Kimura U, Takeuchi K, Kinoshita A, Takamori K, Hiruma M, Suga Y: Treating onychomycoses of the toenail: clinical efficacy of the sub-millisecond 1,064 nm Nd: YAG laser using a 5 mm spot diameter. J Drugs Dermatol. 2012, 11: 496-504. PubMed
Moon SH, Hur H, Oh YJ, Choi KH, Kim JE, Ko JY, Ro YS: Treatment of onychomycosis with a 1,064-nm long-pulsed Nd:YAG laser. J Cosmet Laser Ther. 2014, e-print ahead of publication
Waibel J, Rudnick A, Wulkan AJ: Prospective efficvacy and safety study to evaluate laser with real-time temperature feedback for fungal onychomycosis. Lasers Surg Med. 2013, 12: 1237-1242.
Zhang RN, Wang DK, Zhuo FL, Duan XH, Zhang XY, Zhao JY: Long-pulse Nd:YAG 1064-nm laser treatment for onychomycosis. Chin Med J (Engl). 2012, 125: 3288-3291.
Hees H, Raulin C, Bäumler W: Laser treatment of onychomycosis: an in vitro pilot study. J Dtsch Dermatol Ges. 2012, 10: 913-917. PubMed
Na G, Suh M, Sung Y, Choi S: A decreased growth rate of the toenail observed in patients with distal subungual onychomycosis. Ann Dermatol. 1995, 7: 217-221.
Gupta AK: Onychomycosis: what do we consider/how do we define cure and what are the barriers to achieving it?. J Am Acad Dermatol. 2013, 68: AB11-
- The effectiveness of lasers in the treatment of onychomycosis: a systematic review
Ivan R Bristow
- BioMed Central