Abstract:

Objective To evaluate the efficacy of long pulsed Nd:YAG 1064nm laser for the treatment of distal lateral subungual onychomycosis and to observe the effect on the ultrastructural changes of fungi. Methods Distal lateral subungual onychomycosis cases with typical clinical manifestations and positive fungal microscopy examination were enrolled into this study, and treated with long pulsed Nd:YAG 1064 nm laser for 12 weeks. Clinical efficacy and mycological clearance were evaluated. The ultrastructural changes of long pulsed Nd:YAG 1064 nm laser in Trichophyton rubrum, Trichophyton interdigitale and Candida albicans were exhibited by scanning electron micrograph(SEM). Results Totally, 30 patients with distal lateral subungual onychomycosis (58 nails) were enrolled. There were 22 nails with nail matrix involvement. The clinical effective rate was 58.62% at 6 months after treatment. At the end of the treatment, the clinical effective rates of the nails without and with nail matrix involvement were 61.11%、9.09%,respectively. At 6 months after treatment, those were 80.56%、22.73%, respectively. There were significant differences,respectively(χ²=15.234、18.825,P<0.001、0.001). The mycological clearance rate was 58.62% at 6 months after treatment. At the end of treatment and 6 months after treatment, there was significant difference in the mycological clearance rate between the nails without and with nail matrix involvement(χ²=21.795、23.895,P<0.001、0.001). The results of SEM exhibited that the ultrastructure of the three strains after laser irradiation was damaged. Conclusion Long pulsed Nd:YAG 1064 nm laser was a safe and effective method for the treatment of distal lateral subungual onychomycosis without nail matrix involvement, and the laser could change the cellular ultrastructure of fungi.

Key words: laser therapy, onychomycosis, ultrastructure