Laser therapy for the treatment of onychomycosis : best evidence based practice or not?
- Dembskey, Nadia, Abrahamse, Heidi
- Authors: Dembskey, Nadia , Abrahamse, Heidi
- Date: 2016
- Subjects: Onychomycosis , Resistance , Laser
- Language: English
- Type: Articles
- Identifier: http://hdl.handle.net/10210/241789 , uj:24924 , Citation: Dembskey N, Abrahamse H (2016) Laser Therapy for the Treatment of Onychomycosis: Best Evidence Based Practice or Not?. Clin Res Foot Ankle 4: 211. doi:10.4172/2329-910X.1000211 , ISSN: 2329-910X
- Description: Abstract: Onychomycosis is a very common condition that accounts for 50% of all nail pathologies. Currently 2–5% of the world population suffers from this disorder. It is primarily caused by dermatophytes, but the infection can also be caused by yeasts and non-dermatophyte moulds. Onychomycosis is a therapeutic challenge and recently there has been an increase in resistance to oral and topical antifungal agents, leading to 20–25% relapse and/or reinfection rate. During the past 5 years, the emergence of laser therapy has been the topic of discussion as a newer, safer modality of treatment. Nail clippings and scrapings are the most common methods of sampling for suspected onychomycosis. The simplest method for detecting fungi is by way of 20% potassium hydroxide (KOH) preparations, but lately show insufficient sensitivity in onychomycosis – as much as 40–68%. Fungi can also be grown in culture form; however a 70% sensitivity detection failure rate is seen. Recently, histological fungal detection – in the form of Periodic Acid- Schiff (PAS) stain – has shown high sensitivity at 92% in the detection of fungal elements. The exact mechanism of action of laser is unknown but it is believed that heat disintegrates fungal structures. One of the most appealing characteristics of laser therapy is its ability to deliver energy to the target tissue and avoid systemic side effects at the same time. In 2009 the United Kingdom (UK) Podiatry magazine Podiatry Now published a letter suggesting laser treatment was “possibly the most radical development in the treatment of onychomycosis our profession has ever seen”, although concerns were raised over the unproven efficacy and investment costs involved. Papers have been published investigating the efficacy of lasers for the treatment of onychomycosis. Even though laser therapy provides an alternative option with rapid procedure duration, conflicting evidence is shown in a variety of papers and studies with longer follow-up periods suggest onychomycosis relapse in those treated with laser, which warrants further investigation.
- Full Text:
- Authors: Dembskey, Nadia , Abrahamse, Heidi
- Date: 2016
- Subjects: Onychomycosis , Resistance , Laser
- Language: English
- Type: Articles
- Identifier: http://hdl.handle.net/10210/241789 , uj:24924 , Citation: Dembskey N, Abrahamse H (2016) Laser Therapy for the Treatment of Onychomycosis: Best Evidence Based Practice or Not?. Clin Res Foot Ankle 4: 211. doi:10.4172/2329-910X.1000211 , ISSN: 2329-910X
- Description: Abstract: Onychomycosis is a very common condition that accounts for 50% of all nail pathologies. Currently 2–5% of the world population suffers from this disorder. It is primarily caused by dermatophytes, but the infection can also be caused by yeasts and non-dermatophyte moulds. Onychomycosis is a therapeutic challenge and recently there has been an increase in resistance to oral and topical antifungal agents, leading to 20–25% relapse and/or reinfection rate. During the past 5 years, the emergence of laser therapy has been the topic of discussion as a newer, safer modality of treatment. Nail clippings and scrapings are the most common methods of sampling for suspected onychomycosis. The simplest method for detecting fungi is by way of 20% potassium hydroxide (KOH) preparations, but lately show insufficient sensitivity in onychomycosis – as much as 40–68%. Fungi can also be grown in culture form; however a 70% sensitivity detection failure rate is seen. Recently, histological fungal detection – in the form of Periodic Acid- Schiff (PAS) stain – has shown high sensitivity at 92% in the detection of fungal elements. The exact mechanism of action of laser is unknown but it is believed that heat disintegrates fungal structures. One of the most appealing characteristics of laser therapy is its ability to deliver energy to the target tissue and avoid systemic side effects at the same time. In 2009 the United Kingdom (UK) Podiatry magazine Podiatry Now published a letter suggesting laser treatment was “possibly the most radical development in the treatment of onychomycosis our profession has ever seen”, although concerns were raised over the unproven efficacy and investment costs involved. Papers have been published investigating the efficacy of lasers for the treatment of onychomycosis. Even though laser therapy provides an alternative option with rapid procedure duration, conflicting evidence is shown in a variety of papers and studies with longer follow-up periods suggest onychomycosis relapse in those treated with laser, which warrants further investigation.
- Full Text:
The efficacy of laser therapy for the treatment of onychomycosis
- Authors: Dembskey, Nadia
- Date: 2018
- Subjects: Onychomycosis - Treatment , Nails (Anatomy) - Diseases - Treatment , Nails (Anatomy) - Diseases , Lasers in medicine
- Language: English
- Type: Masters (Thesis)
- Identifier: http://hdl.handle.net/10210/296928 , uj:32358
- Description: Abstract: Onychomycosis is a chronic fungal infection of the finger- and toenails. It is a very common infection that accounts for approximately 50% of all nail pathologies worldwide. This condition is a therapeutic challenge and recently there has been an increase in resistance to current treatment regimes, namely oral and topical antifungal agents. During the last couple of years, laser therapy for the treatment of Onychomycosis has been a topic of discussion as a newer and safer modality of treatment. The aim of this research was to explore the effectiveness of 1064 nm diode laser therapy for the treatment of Onychomycosis. An exploratory, prospective, quantitative, single-blinded study was conducted on patients with toenail Onychomycosis. Forty-five patients were randomly grouped into three groups and digital images of the toenails were taken to establish the severity of fungal infection. All patients received standard Podiatric treatment before each treatment with laser or control. Nail clippings were taken at the site of infection for PAS staining and fungal microscopy and culture to identify fungal elements and isolate the causative pathogen prior to treatment. Group 1 (control) received 5% topical Amorolfine lacquer to apply to the affected nails once-weekly. Group 2 received 1064 nm diode laser treatment at 10 mW/s wavelength, hallux 790 J/cm2 frequency and lesser digits 390 J/cm2 frequency. Group 3 received 1064 nm laser treatment at 10 mW/s wavelength, hallux 1 100 J/cm2 frequency and lesser digits 500 J/cm2 frequency. These two groups were compared to the control group, and as such, did not receive any topical antifungal therapy. Immediately after each individual laser treatment within each group, nail temperature reached was taken with a surface thermometer, omitting the control group. Specimen diagnostic results indicate that PAS staining was much more sensitive in identifying Onychomycotic infections (91.1%), compared to Fungal Microscopy (44.4%) at week 1. If Fungal Microscopy (and culture) was performed as the only diagnostic test, 55.6%... , M.Tech. (Podiatry)
- Full Text:
- Authors: Dembskey, Nadia
- Date: 2018
- Subjects: Onychomycosis - Treatment , Nails (Anatomy) - Diseases - Treatment , Nails (Anatomy) - Diseases , Lasers in medicine
- Language: English
- Type: Masters (Thesis)
- Identifier: http://hdl.handle.net/10210/296928 , uj:32358
- Description: Abstract: Onychomycosis is a chronic fungal infection of the finger- and toenails. It is a very common infection that accounts for approximately 50% of all nail pathologies worldwide. This condition is a therapeutic challenge and recently there has been an increase in resistance to current treatment regimes, namely oral and topical antifungal agents. During the last couple of years, laser therapy for the treatment of Onychomycosis has been a topic of discussion as a newer and safer modality of treatment. The aim of this research was to explore the effectiveness of 1064 nm diode laser therapy for the treatment of Onychomycosis. An exploratory, prospective, quantitative, single-blinded study was conducted on patients with toenail Onychomycosis. Forty-five patients were randomly grouped into three groups and digital images of the toenails were taken to establish the severity of fungal infection. All patients received standard Podiatric treatment before each treatment with laser or control. Nail clippings were taken at the site of infection for PAS staining and fungal microscopy and culture to identify fungal elements and isolate the causative pathogen prior to treatment. Group 1 (control) received 5% topical Amorolfine lacquer to apply to the affected nails once-weekly. Group 2 received 1064 nm diode laser treatment at 10 mW/s wavelength, hallux 790 J/cm2 frequency and lesser digits 390 J/cm2 frequency. Group 3 received 1064 nm laser treatment at 10 mW/s wavelength, hallux 1 100 J/cm2 frequency and lesser digits 500 J/cm2 frequency. These two groups were compared to the control group, and as such, did not receive any topical antifungal therapy. Immediately after each individual laser treatment within each group, nail temperature reached was taken with a surface thermometer, omitting the control group. Specimen diagnostic results indicate that PAS staining was much more sensitive in identifying Onychomycotic infections (91.1%), compared to Fungal Microscopy (44.4%) at week 1. If Fungal Microscopy (and culture) was performed as the only diagnostic test, 55.6%... , M.Tech. (Podiatry)
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