Antifungal efficacy of lasers against dermatophytes and yeasts in vitro

Figures & data

Table I. Common laser systems available for treatment of onychomycosis. Applied laser parameters for the treatment of onychomycosis using a Nd:YAG laser and the laser parameter range used.

Wavelength (nm)	Fluence (J/cm^2)	Pulse duration (ms)	Spot size (mm)	System name Manufacturer	Reference/comments
405/635	0.95 per diode	n.a. 12 min per foot	(2862)	Lunula Primogent Solutions	97% of treated patients with improvements according to the manufacturer
870/930	212/414	n.a.	n.a.	Noveon/Nomir Technologies Naillaser, Medical Technologies	Treatment of mild, moderate, and severe onychomycosis using 870- and 930-nm light exposure: 85% ‘clear nail linear extent.’ Disposable automated toe pod system. FDA USA 510 k:071815
1064	<200	0.3–200	1–1.5	Joule, Clear Sense Sciton	Thermal sensor FDA USA 510 K: K111483 Clear Sense
1064	35–40	25	4	SP Dualis, Fotona	[33, 36] Clear Steps
1064	5–40	0.1–1	5	Genesis Plus, Cutera	White paper FDA USA 510 k:K103626 Thermal sensor
1064	223	0.65	2	Aerolase, Light pod Neo	[32]
1064	25.5	0.45	1–1.5 defocused up to 6 mm	Pin Pointe Cynosure	FDA USA 510 K: K093547 K093545
1320		0.45	3–10	CoolBreeze/CoolTouch Varia, CoolTouch	79.6% positive response after 2 treatments FDA USA 510 K: K103338
1440	250 mJ/Puls	0.1		AccuSculpt Lutronic	20 Hz
532 qs + 1064  long pulsed	500–1200 mJ/pulse 20–450 J/cm^2	0.02 0.1–0.3	3 1	Alma Harmony	Clear Choice FDA USA 510 K: K113810
1064 qs	4–12	0.003–0.01	2.5–6	Q-Clear, Light Age	FDA USA 510 K: K0110370

n.a., not applicable.

Figure 1. Illustration of how the fungi were transferred to culture plates after incubation.

Figure 2. Temperatures within water and cell culture media containing pathogens in response to repetitive laser treatments (stacks) at various parameter settings.

Table II. Efficacy of 980-nm irradiation of pathogens in liquid culture media as measured 6 days post-treatment on culture plates.

Pathogen	LEDA	Temperature	Results 6 days post-treatment
C. guilliermondii	27 J/cm^2, 6 ms	58 °C	Complete clearance
N = 5	12 × 12 mm
	318 pulses, ∼9 min
	27 J/cm^2, 6 ms	37–45 °C	Reduced growth
	12 × 12 mm
	318 pulses, ∼9 min
C. albicans	27 J/cm^2, 6 ms	48 °C	No inhibition
N = 5	12 × 50 mm
	318 pulses, ∼21 min
	27 J/cm^2, 6 ms	45–47 °C	No inhibition
	12 × 12 mm
	318 pulses, ∼9 min
C. parapsilosis	27 J/cm^2, 6 ms	58 °C	Reduced growth
N = 5	12 × 50 mm
	318 pulses, ∼21 min
	27 J/cm^2, 6 ms	37–45.5 °C	Reduced growth
	12 × 12 mm
	318 pulses, ∼9 min
T. interdigitale	27 J/cm^2, 6 ms	45.5 °C	Reduced growth
N = 7	12 × 12 mm
	318 pulses, ∼9 min
	27 J/cm^2, 6 ms	55 °C	Complete clearance
	12 × 50 mm
	318 pulses, ∼21 min
	27 J/cm^2, 6 ms	41.5–46 °C	Reduced growth
	12 × 12 mm
	318 pulses, ∼9 min
M. gypseum	27 J/cm^2, 6 ms	45.5–51 °C	Reduced growth
N = 5	12 × 12 mm
	318 pulses, ∼9 min
T. rubrum	30–51 J/cm^2	n.m.	Reduced growth n = 5
N = 5	12–18 ms	Increased growth
	12 × 12 mm	n = 1 (33 J/cm^2, 12 ms)
	40–100 pulses

N, the number of repetitions per strain.

Table III. Efficacy of 1064-nm irradiation of pathogens in liquid culture media as measured 6 days post-treatment on culture plates.

Pathogen	Pulses	50 J/cm^2 40 ms	100 J/cm^2 40 ms	240 J/cm^2 40 ms
C. guilliermondii
N = 5	2			No inhibition
C. albicans
N = 5	2		No inhibition
C. parapsilosis
N = 5 240 J/cm^2  N = 5 100 J/cm^2	2		Growth inhibition
N = 5 50 J/cm^2	15	Growth inhibition	Growth inhibition
T. interdigitale
N = 5 240 J/cm^2	15		Temporary growth  inhibition day 1–2
N = 5 100 J/cm^2	12		Temporary growth  inhibition day 1–2
N = 5 50 J/cm^2	12	No inhibition
M. gypseum
N = 5 240 J/cm^2	15	Increased growth	Increased growth	Increased growth
N = 5 100 J/cm^2	12	Increased growth	Increased growth	Increased growth
N = 5 50 J/cm^2	12	Increased growth	Increased growth	Increased growth

T. rubrum
N = 1 40 J/cm^2, 15 ms		40 J/cm^2	40 J/cm^2	70 J/cm^2	100 J/cm^2	100 J/cm^2
N = 2 40 J/cm^2, 30 ms		15 ms	30 ms	40 ms	65 ms	90 ms
N = 1 70 J/cm^2, 40 ms	100	Increased growth		No reduced growth		–
N = 1 100 J/cm^2, 65 ms	31	–	Reduced growth	–	–
N = 1 100 J/cm^2, 90 ms	100 pulses, 3 Hz	–	No reduction or  increase in growth	–	–

N, the number of repetitions per strain.

Figure 3. Histology of a nail clipping after applying a 1064-nm long pulsed Nd:YAG laser at a fluence of 70 J/cm² and a pulse duration of 40 ms (three passes), PAS (Periodic acid Schiff).

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