The efficacy of fractional carbon dioxide (CO₂) laser combined with terbinafine hydrochloride 1% cream for the treatment of onychomycosis

ABSTRACT

Background: Although systemic and topical antifungal agents are widely used to treat onychomycosis, oral medications can cause adverse effects and the efficacy of topical agents is not satisfying. Currently, laser treatment has been studied for its efficacy in the treatment of onychomycosis. Our study was aimed to evaluate the efficacy of fractional carbon dioxide (CO₂) laser treatment combined with terbinafine cream for 6 months in the treatment of onychomycosis and to analyze the influencing factors. Methods: A total of 30 participants (124 nails) with clinical and mycological diagnosis of onychomycosis received fractional CO₂ laser treatment at 2-week interval combined with terbinafine cream once daily for 6 months. The clinical efficacy rate (CER) was assessed from the percentage of fully normal-appearing nails or nails with ≤5% abnormal appearance, and the mycological clearance rate (MCR) was assessed from the percentage of nails with negative fungal microscopy. Results: The CER was evaluated at 3 time points: at the end of treatment (58.9%), at 1 month after the last treatment (63.5%), and at 3 months after the last treatment (68.5%). The MCRs at 1 month and 3 months after the last treatment were 77.4 and 74.2%, respectively. The evaluation of influencing factors showed significantly higher CER (p < 0.05) in nails of participants with age <50 years, distal lateral subungual onychomycosis (DLSO), superficial white onychomycosis (SWO), nail thickness <2 mm, affected first-to-fourth finger/toenails, Trichophyton rubrum, and Trichophyton mentagrophytes. All participants experienced tolerable mild burning sensation during laser treatment, but there were no other adverse reactions reported. Conclusions: Fractional CO₂ laser treatment combined with terbinafine cream for 6 months was an effective and safe method for the treatment of onychomycosis. There were 5 factors that positively influenced the treatment outcome: age, clinical type of onychomycosis, nail thickness, involved nail, and species of fungus.

KEYWORDS:

• Fractional CO₂ laser
• onychomycosis
• terbinafine cream

Acknowledgments

The authors wish to thank Dr. Jian-bin Su and Pro. Xu Miao for providing helpful suggestions during the preparation and editing of the manuscript. All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Research Committee of The First affiliated Hospital of Nanjing Medical University, Nanjing, China, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Funding

This work was supported by Grants from the China National Natural Science Foundation (81573072, 81371757) and the Priority Academic Program Development (PAPD) of Jiangsu Higher Education Institutions (JX10231801), and Special Project Fund for Clinical Research of Luliconazole, Professional Committee of Dermatology and Venereology, Chinese Association of Integrative Medicine (2015).

Additional information

Funding

This work was supported by Grants from the China National Natural Science Foundation (81573072, 81371757) and the Priority Academic Program Development (PAPD) of Jiangsu Higher Education Institutions (JX10231801), and Special Project Fund for Clinical Research of Luliconazole, Professional Committee of Dermatology and Venereology, Chinese Association of Integrative Medicine (2015).