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1064nm diode laser use for treating nail fungus results of a prospective open treatment of 82 toenails

BACKGROUND
Onychomycosis is one of the most prevalent nail disorders in adults, where conventional topical therapy is often protracted and in most cases ineffective. On the other hand, systemic/oral therapy is not suitable for all patients and might be associated with relevant side effects. Therefore, laser therapy can be used as an alternative to or extension of existing treatment protocols.


OBJECTIVES
We used diode laser treatment for onychomycosis to evaluate the efficacy of this treatment as single therapy as well as in combination with an ongoing antimycotic treatment.


METHODS
We used a 1,064-nm diode laser in pulse mode with a spot size of 4 mm. The laser's settings were: 8 W, with a pulse duration of 80 ms and a repetition rate of 5.6 Hz; the energy fluence/pulse was 5.1 J/cm(2), and a total energy of 250-500 J for large and/or thickened nails (digit I), 120-200 J for medium nails (digits ll-IV) and 60-120 J for small and/or very thin nail plates (digit V) was counted in the laser display. Two to three passes where applied continuously over the entire area of the nail (nail plate, nail folds and eponychium) in a grid pattern. Eighty-two affected toenails were treated at least twice every 8 weeks; all nails treated were clinically diagnosed as onychomycosis. The evaluation of the treated nails was conducted by two dermatologists, initially by semiquantitative visual examination, followed by evaluation with the Onychomycosis Severity Index (OSI). In addition, the patients were asked to state their satisfaction with the treatment and its results in a written questionnaire...