Laser plus mechanical abrasion for nail fungus falls flat

In the treatment of patients with onychomycosis, the use of laser plus mechanical abrasion fails to produce mycological cure despite improvements in affected toenails, according to the results of a pilot study.

In the study, nine patients (median age 55.6 years) with 16 clinically involved nails underwent eight sessions of treatment involving a mechanical drill of the friable nail material followed by a laser treatment. The latter comprised four 2-minute cycles per nail with a median power of 3 W that provided 240 J each. Treatments were performed twice a week within a period of 28–44 days.

All patients completed the study, none of whom withdrew due to pain or discomfort. They tolerated the treatment well and expressed high satisfaction.

In terms of efficacy, eight patients (89 percent) exhibited a positive clinical improvement at the end of the treatment cycles. The ninth patient still showed evidence of the dystrophic nail and had no significant clinical improvement.

Clinical healing occurred in three patients (33.3 percent), while evidence of partial clinical cure (decreasing area of dystrophic nail) was observed in four (44.4 percent).

Positive mycological cultures were seen in six patients (67 percent) at baseline and only two (22 percent) at the end of treatment (p=0.07). However, histopathologic examination by periodic acid Schiff staining remained positive in all patients (100 percent).

In light of the findings, additional local or systemic antimycotic agents should be used in combination with laser and abrasion in order to avoid clinical recurrences.