The effectiveness of 1,064-nm long-pulsed Nd:YAG laser in the treatment of severe onychomycosis

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INTRODUCTION: Severe onychomycosis in the elderly is a common condition and generally difficult to treat. Long-pulsed Nd:YAG (LPNY) laser has been found to be useful in the treatment of onychomycosis. We sought to evaluate the effectiveness of 1,064-nm LPNY laser in the treatment of severe onychomycosis. MATERIALS AND METHODS: Forty nails in 13 patients with severe onychomycosis were divided into two groups. Each group received eight treatment sessions at one-week intervals with 1,064-nm LPNY laser. Parameters for group A were 0.3 ms pulse duration, 5 mm spot size, 16 J/cm(2) fluence, and 10 Hz frequency, and those for group B were 0.6 ms, 2 mm, 225 J/cm(2), and 5 Hz. Clinical and mycological clearance were evaluated at 12 and 24 weeks after initial treatment. RESULTS: Clinical improvements at 12 and 24 weeks presented 47.6 and 57.1% in group A, and 26.3 and 36.8% in group B. In the treated nails with clinical improvement, mycological positive rates at 24 weeks were approximately 40% in both groups. DISCUSSION: The treatment of onychomycosis using 1,064-nm LPNY laser were incomplete in clinical and mycological improvement, and it could imply a lot of potential recurrence. We suggest that 1,064-nm LPNY laser for severe onychomycosis should need additional or combined therapy with other therapeutic options.