Treatment of onychomycosis using the 1 064 nm Nd:YAG laser: a clinical pilot study

Background: Nd:YAG lasers could be a safe and effective treatment modality for onychomycosis, without the side effects of drugs. Long and short-pulsed Nd: YAG lasers were used in this clinical study in a side-comparison manner without removal of onychomycotic nail material before treatment. Patients and Methods: Big toenails of 10 patients were treated twice in a side-comparison manner with a short-pulsed Nd: YAG laser. Before treatment and after 9 months of trial, fungal cultures were taken and a histological examination was performed. Two independent investigators rated clearance using the "Onychomycosis Severity Index" and standardized photographs. Results: OSI-Scores decreased for 3.8 (15 %; p = 0.006), 4.8 (19 %; p = 0.0002) and 2.9 points (12 %; p = 0.04) within 3, 6 and 9 months. Positive culture was noted in 35 % (p = 0.0003) after 9 months. Classification of severity of onychomycosis showed no change. The difference between the treatment regimens was not significant. Conclusions: These results suggest that treatment of onychomycosis with the Nd:YAG laser without removing mycotic nail material can lead to a temporary clinical improvement, a reduction of positive fungal cultures and an improvement of the Onychomycosis Severity Index. The treatment regimen should be optimized to be used as an effective antimycotic monotherapy.