Fractional CO2-assisted photodynamic therapy improves the clinical outcome and patient's satisfaction in toenail onychomycosis treatment: an intra-patient comparative single-center study. (2nd January 2022)

• Record Type: Journal Article
• Authors: Abdallah, Marwa; Abu-Ghali, Mustafa M.; El-Sayed, Mohamed Taha; Soltan, Marwa Y.
• Is Part Of: Journal of dermatological treatment. Volume 33:Number 1(2022)
• Page Start: 542
• Page End: 549
• Publication Date: 2022-01-02
• Subjects: Onychomycosis -- photodynamic therapy -- fractional CO2; Skin -- Diseases -- Treatment -- Periodicals; Skin Diseases -- drug therapy -- Periodicals; Skin Diseases -- therapy -- Periodicals; 616.5
• DOI: 10.1080/09546634.2020.1771252
• Languages: English
• ISSNs: 0954-6634

Abstract

Abstract: Background: Device-based therapies have been used for onychomycosis patients with intolerance to systemic treatments. Photodynamic therapy (PDT) improves onychomycosis, while fractional carbon dioxide (FrCO2 ) augments the topical drug delivery. Comparative studies between PDT alone and laser-assisted one are lacking. Objective: We aimed to evaluate the efficacy of PDT alone versus FrCO2 -assisted PDT for treatment of onychomycosis. Methods: Twenty-one patients with bilateral onychomycosis of toenails with nearly the same degree of affection were enrolled in this prospective intra-patient-controlled study. The right affected toenail was treated via PDT alone. The left toenail was treated via a FrCO2 followed immediately by PDT. The sessions were bimonthly for a total of six sessions. Direct microscopy, fungal cultures, clinical evaluation, onychomycosis severity index scoring, and patient's satisfaction were assessed before and 12 weeks after the last session. Results: Both treatments reduced significantly the onychomycosis severity index ( p < .05) without significant difference between them. The improvement in nail appearance and patient's satisfaction were higher in laser-assisted PDT than PDT alone ( p < .05). Conclusion: Both treatments effectively reduced the severity of onychomycosis with a high degree of safety and tolerability. Fractional CO2 -assisted PDT enhanced the clinical outcome via improving the nail appearance and patient's satisfaction. Key message: Photodynamic therapy has a good success rate in clearing onychomycosis. Addition of fractional CO2 to photodynamic therapy improves the nail appearance and induces better satisfaction to treatment.