Photodynamic therapy for onychomycosis. Case report and review of the literature

Background: Onychomycosis is one of the most prevalent fungal infections in the population with a higher rate of treatment failures. Photodynamic therapy (PDT) is based on the use of photosensitizers with light of an accurate wavelength, and in the presence of oxygen, reactive oxygen species are produced which induce cell death. PDT is widely used to treat non-melanoma skin cancer, and other indications are being investigated, especially in superficial infections. Aims: To determine the effectiveness of PDT in a case of onychomycosis caused by moulds. Methods: A 75-year-old woman was diagnosed with onychomycosis caused by Acremonium sclerotigenum in the 5th finger. She was treated with 3 sessions of PDT with methyl-aminolevulinate (MAL) separated by 15 days. Results: The patient achieved mycological and clinical cure and remains asymptomatic after 12 months of follow up. Conclusions: This case illustrates the potential usefulness of MAL-PDT for onychomycosis. Its effectiveness, lack of adverse effects and satisfaction on the part of physicians and patients, suggest a promising future for this therapy in the management of superficial fungal infections, such as onychomycosis. (C) 2010 Revista Iberoamericana de Micologia. Published by Elsevier Espana, S.L. All rights reserved.