| Background Onychomycosis is the infection of nail caused by anthropophilic dermatophyte fungi and(or) non-dermatophyte, responsible for up to 50% of diseases of the nail. Studies of sampled material from infected nails have identified that over 90% of onychomycoses are caused by two dermatophytes: Trichophyton rubrum and Trichophyton mentagrophytes. In 2013 Gupta etal have reported that Onychomycosis is a fungal infection of the nail that affects 10- 30% of the global population. It not only causes cosmetic disfigurement, but also leads to morbidity,which interferes with normal living, negatively impacts Qo L, and occasionally results in significant pain and discomfort. Therefore, patients with onychomycosis need treatment. Currently accepted treatments are oral therapies. They can obtain preferable clinical and mycology curative effect.However, they also complicate with potential drug interactions, allergic or systemic effects.Besides,topical treatments have difficulty in penetrating the keratinized nail plate and then being absorbed into the underlying tissue,thus its curative effect is poor. Laser therapy is a new treatment that is being vigorously developed, such as Nd:YAG lasers,Modelocked Ti:Sapphire,Long Pulse Laser,Short Pulse Laser,Near Infrared Diode Lasers,which have been used in Onychomycosis tentatively at present. Laser therapy brings targeted therapy and less adverse effect.However, its mechanism of action, efficacy and adverse reactions lacks systematic clinical and experimental research. In 2012, Lumenis company launched the ultra pulse CO2 laser Toe Touch model to be used in onychomycosis. In this study,we open a randomized clinical study to explicit the clinical curative effect and adverse reaction of the ultra pulse CO2 laser in the treatment of onychomycosis.OBJECTIVE The efficacy and safety of Acupulse CO2 laser for onychomycosis therapy was evaluated in this study.Methods Clinical patients of onychomycosis with typical clinical manifestations and direct fungal microscopy with positive results were enrolled. All the patients were given Acupulse CO2 laser treatment for eight times. SCIO and OSI clinical scores based on patient’s age, type of onychomycosis, thickness of nails, area and length of infection were calculated to evaluate the efficacy at before and after treatment, one-month follow-up, and 3-month follow-up. Mycological clearance rate based on direct microscopy and fungal culture were calculated and compared as well.All the side effects of Acupulse CO2 laser were recorded during the treatment.Results 20 patients with 75 target nails were enrolled in research, while 18 cases with 71 nails were given complete treatment and follow-up. The mean±SD of SCIO scores at before treatment, the end of treatment, 1-month and 3-month follow-up were 13.07 ± 6.47, 9.03 ± 6.14, 8.51 ± 6.99, and 7.89 ± 7.26, respectively, while OSI scores were 21.11±11.94, 13.63±12.10, 14.18±13.65, and 13.70±13.93, respectively. The mycologyical clearance rates at the end of treatment, one-month follow-up, and 3-month follow-up were 57.75%, 59.15%, and 61.97%,respectively. Compared with before treatment, there were statistically significant(P <0.05) either SCIO and OSI scores or fungal clearances at the end of treatment, 1-month, and 3-month follow-up. Several patients felt mild pain during the therapy. No other adverse reaction such as subungual hemorrhage was reported.ConclusionAcupulse CO2 laser is a safe and effective method for different types of clinical onychomycosis. |
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