Abstract

Background: Onychomycosis is a serious medical condition that affects both the health and quality of life of patients.
Aim: This study investigates the use of a fractional 1064 nm Q-switched laser system to treat a patient affected by toenail onychomycosis and onychodystrophy.
Methods: Patient received a 1064 nm Nd: YAG laser session, 2 treatments at 2 months. Two passes were done with a 1-minute interval. The clinical outcome was assessed after a 1-year and 5-month follow-up compared to the baseline.
Results: at the follow-up, the nail appeared clinically normal, and healthy nail regrowth was fully restored. Conclusion: the study device eliminates micosys by emitting very short pulses creating impact energy which mechanically destroying only the fungi, with few adverse effects, notably in terms of tissue heat and the level of pain experienced during the process.

Keywords:1064 Nm Q-Switched Laser; Toenail Onychomycosis; Onychodystrophy

Introduction

Onychomycosis is a serious medical condition that affects both the health and quality of life of patients. Antifungal drugs have long been the cornerstone of treatment; however, their effectiveness is limited (40-80% cure rates) due to subtherapeutic concentrations reaching the nail bed and poor permeability of the nail plates to topically administered drugs [1]. Laser treatment for onychomycosis is an emerging therapy that uses focused light to target and eliminate the fungal infection in the nails. The most used type of laser for treating onychomycosis is the Nd: YAG laser, though other types, such as CO2 lasers and diode lasers, have also been explored [2].

Laser treatment is non-invasive and typically involves several short sessions, with each session lasting about 10-15 minutes; there is no downtime, and patients can typically resume normal activities immediately after treatment. The treatment is often repeated over the course of a few weeks or months, depending on the severity of the infection. Laser treatment is generally considered safe with fewer side effects compared to systemic antifungal treatments. The laser emits light energy that penetrates the nail and targets the fungal cells, causing them to break down and die, with photothermal or mechanical damage, depending on the wavelength and the pulse frequency employed. The heat from the laser may also help to stimulate the nail bed, encouraging faster and healthier nail growth. Overall, laser therapy for onychomycosis is a growing treatment option.

In our retrospective investigation a fractional 1064 nm Q-switched laser system (Toro, Deka M.E.L.A., Calenzano, Italy) was used to treat the patient. The system provides nanoseconds pulses and can be equipped with a skin contact sensor. The case report of a 35-year-old Caucasian woman having a clinical and mycological diagnosis of toenail onychomycosis and onychodystrophy, was reported. Symptoms have been occurring for approximately 11 months and the patient refused to take oral antifungal agents. Patient received a 1064 nm Nd: YAG laser session, 2 treatments at 2 months, with the following parameters: fluence: 1.8 J/cm2, spot size: 8 mm fractional. Two passes were done with a 1-minute interval. We assessed the clinical outcome after a 1-year and 5-month follow-up compared to the baseline; at the follow-up, the nail appeared clinically normal, and healthy nail regrowth was fully restored [Figure 1].

The use of fractional emissions in Q-switched lasers has proven to be safe and effective in the management of onychomycosis, and in other treatments as well [3]. Fungal hyphae can be eradicated by very short pulses of Q-switched laser [4]; indeed Galvan Garcia, suggests that the Q-switched Nd: YAG laser produces high-energy pulses, with numerous repetitions, with minimal tissue heating, which selectively damages fungi through mechanical impact [5]. In conclusion, the study device eliminates micosys by emitting very short pulses creating impact energy which mechanically destroying only the fungi, with few adverse effects, notably in terms of tissue heat and the level of pain experienced during the process.

Conflicts of Interest

LP, LR, IF and TZ are employed at El. En. Group. The other authors have no conflicts of interest to declare.

Contributions

(I) Conception and design: GL,GC, MS; (II) Administrative support: GL,TZ, MS; (III) Provision of study materials or patients: GL,GC, TZ, MS; (IV) Collection and assembly of data: GL,GC, LP, IF, LR, TZ, MS; (V) Data analysis and interpretation: GL,GC, LP, IF, LR, TZ, MS ; (VI) Manuscript writing: All authors. (VII) Final approval of manuscript: All authors

Institutional Review Board Statement

The study was conducted in accordance with the principles of Declaration of Helsinki. Ethical approval was not required as the study device is already CE marked since 2024. No activity was carried out outside the scope of the device intended purpose or that no additional invasive or burdensome procedures were carried out compared to procedure performed under the normal condition of use of the device.

Informed Consent Statement

Participants in the study provided their informed consent.

References

1. Meretsky CR, Friday BL, Schiuma AT (2024) Efficacy of Laser Therapy in Comparison with Other Methods for the Treatment of Onychomycosis: A Systematic Review and Meta-Analysis. Cureus 16(5): e59720.
2. Weiwei Ma, Chenchen Si, Lorna Martin Kasyanju Carrero, Hou-Fang Liu, Xu-Feng Yin, et al. (2019) Laser treatment for onychomycosis: A systematic review and meta-analysis. Medicine (Baltimore) 98(48): e17948.
3. Giuseppe Lodi, Gaia Fasano, Steven Paul Nisticò, Luigi Bennardo, Giovanni Cannarozzo, et al. (2022) Five hundred and thirty-two-nanometer Q-switched Nd: Yag laser with larger fractional spot: A novel and safe technique to treat Café au lait macule-A case report. Dermatol Ther. 35(9): e15681.
4. Vural E, Winfield HL, Shingleton AW, Horn TD, Shafirstein G (2008) The effects of laser irradiation on Trichophyton rubrum growth. Lasers Med Sci 23(4): 349-353.
5. Galvan Garcia HR (2014) Onychomycosis: 1064-nm Nd: YAG q-switch laser treatment. J Cosmet Dermatol 13(3): 232-235.