Is Laser Therapy an Effective Alternative Treatment for Onychomycosis in Patients where the Hepatotoxity of Oral Antifungals is of Concern?

OBJECTIVE: The objective of this selective EBM review is to determine whether or not, “Is laser therapy an effective alternative treatment for onychomycosis in patients where the hepatotoxicity of oral antifungals is of concern?” STUDY DESIGN: Review of three English language primary studies, published between 2010 and 2012. DATA SOURCES: Two randomized controlled trials (RCTs) and one prospective cohort study were found using Cochrane Systematic Reviews and PubMed. These studies analyzed the effectiveness of laser therapy in patients with onychomycosis. OUTCOMES MEASURED: Main outcomes measured were nail clearance and mycological assessment. Nail clearance was determined clinically using photographs taken at different intervals and mycological assessment was determined by microscopic exam. Adverse effects were tracked in all studies and patient satisfaction was considered in one study. The tools used to assess significance of outcomes measured were p-values, percentage of nail clearance, and negative mycological assessment. RESULTS: All three studies showed a significant nail clearance and fungal culture after laser therapy intervention. In the Ladsman et al study, it was shown using an 870 and 930-nm laser improved nail clearance by at least 3mm (p\u3c0.0073) and negative fungal cultures in 42% of the toes after one treatment and 75% on day 60 with an (ABI of 40%).1 In the Zhang et al study, the Long-Pulse 1064-nm laser showed no significant difference in treatment duration, but did show positive improvement in nail clearance and fungal cultures regardless the duration of treatment.2 In the Kimura et al prospective cohort study, it was shown using the Sub-Millisecond 1064-nm laser showed complete clearance in 51% and significant clearance in 81% of patients. Of the 51% with complete clearance, they also were 100% negative on fungal culture.3 CONCLUSSION: The results of one RCT and one cohort study which compared before and after treatment groups demonstrated that laser therapy may be an effective treatment for onychomycosis in patients that may not be able to take oral antifungals for reasons medically indicated. One RCT compared effectiveness of varied treatment durations and found no significant difference between the two groups