Efficacy of Itraconazole Pulse Therapy Versus Q-Switched Nd-YAG Laser Versus Combination of Both in the Treatment of Onychomycosis- A Single-Blind Randomized Control Trial

Background: Onychomycosis is a fungal infection of the nails. Oral itraconazole inhibits lanosterol-14α demethylase, impairing fungal cell membrane synthesis. The 1064 nm Q -switched Nd:YAG laser produces photothermolytic and photomechanical effects on fungi. Since both act via different mechanisms, their combination may offer additive benefits. Objectives: To compare the efficacy of oral itraconazole pulse therapy, 1064 nm Q -switched Nd:YAG laser therapy, and their combination in treating onychomycosis. Methods: Ninety Potassium hydroxide(KOH) mount- and culture-positive patients were randomized into 3 groups: itraconazole pulse (Group A), laser therapy (Group B), or combination therapy (Group C). Patients were followed for 9 months with 3-month interval assessments. Onychomycosis Severity Index (OSI), KOH mount, and culture were evaluated at each visit. Complete cure, clinical and mycological cure, effectiveness, and failure rates were compared. Results: All groups showed significant OSI reduction from baseline ( P < .001), with no significant intergroup differences ( P > .05). Clinical cure occurred in 20 patients (74.07%) in Group A, 20 (74.07%) in Group B, and 20 (80%) in Group C. No relapse occurred during follow-up. KOH and culture results did not differ significantly among groups. Conclusion: Laser therapy, alone or with itraconazole, was as effective as itraconazole pulse therapy. Given its efficacy and absence of systemic side effects, the Nd:YAG laser offers a safe alternative in managing onychomycosis.