Assessing the Therapeutic Efficacy of Photodynamic Therapy, Fractional CO₂ Laser and Its Combination in the Treatment of Onychomycosis

Onychomycosis, a common fungal nail infection, poses challenges for traditional treatments due to long durations, liver toxicity risks, resistance, and poor nail penetration. So, alternative management approaches, which could involve combination therapy or methods to enhance topical drug delivery for optimal treatment efficacy, should be considered. This study evaluates the effectiveness of combining photodynamic therapy (PDT) with fractional CO2 laser treatment. Forty-five patients with onychomycosis were included in the study. Patients were randomly assigned to three groups: PDT alone, fractional CO2 laser alone, and a combination of both. The treatment efficacy was evaluated based on clinical and mycological examinations and patient satisfaction. The combined therapy group showed the best results, with 86.7% testing negative for onychomycosis and 26.7% achieving full nail clearance. Posttreatment satisfaction levels showed no significant differences among groups (p = 0.198). The combination of PDT and fractional CO2 laser appears more effective than either therapy alone, though further research is needed to confirm long-term benefits. Incorporating combined therapy into clinical practice could enhance treatment outcomes for patients with onychomycosis.