Urea versus fractional Er:YAG laser pretreatment of methylene blue photodynamic therapy in the treatment of moderate toenail onychomycosis: short- and medium-term effects

Archives of Dermatological Research · 2 authors, 2 centres

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TL;DR

Both methods were safe and effective, with urea pretreatment showing a higher complete cure rate at 40 weeks.

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Both groups showed clinical and mycological improvement. The laser group showed earlier clinical improvement at 28 weeks but experienced a rebound in subsequent weeks. No statistically significant differences were detected between groups for main outcome scores, likely due to the small sample size. Both pretreatments were well-tolerated, with mild dermal irritation reported in two urea-treated patients. The authors conclude that both urea and laser pretreatment are safe and effective alternatives, with urea being more effective in the medium term despite requiring daily application.

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RCT

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dermatology

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ORIGINAL PAPER

PMC10085931

Urea versus fractional Er:YAG laser pretreatment of methylene blue photodynamic therapy in the treatment of moderate toenail onychomycosis: short- and medium-term effects

Archives of Dermatological Research

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ABSTRACT

Abstract Keratolytic properties of urea 40% have long time used for the treatment of onychomycosis. Fractional ablative lasers enhance the delivery of topically applied photosensitizers improving photodynamic therapy (PDT) efficacy. The aim of this study was to compare the short- and medium-term efficacy of a pretreatment with urea 40% and fractional Er:YAG (Fr Er:YAG) laser radiation before PDT mediated by methylene blue (MB) for moderate toenail onychomycosis. Twenty-first-toe toenails were randomized to receive either urea 40% (Group I) or Fr Er:YAG laser (Group II) pretreatment and 9 sessions of MB/PDT over the course of 16 weeks. At baseline, 28- and 40-week follow-ups, clinical efficacy was assessed by digital photographs [allowing determination of the onychomycosis severity index (OSI)], whereas mycological efficacy was assessed by histological examination and fungal culture. Details of the side effects and patients’ satisfaction were also recorded. In both groups, a significant decrease in OSI values was observed at the 28-week follow-up and a slight rebound at the 40-week follow-up. The percentage of nail involvement decreased significantly in both groups at the 28-week follow-up, to continue declining gently in Group I at 40 weeks, in contrast to the rebound observed during this period in Group II. The mycological cure rate was 20% and 30% at 28-week follow-up and 70% and 40% at 40-week follow-up, in Group I and II, respectively. Patients reported being fairly satisfied, and no side effects were detected in any groups. Although both pretreatments favor the action of PDT for the treatment of onychomycosis, the use of urea at 40% is more effective in the medium term. Keywords: Fractional Er:YAG laser, Urea, Methylene blue, Onychomycosis, Photodynamic therapy

CITATION EXPORT

Enrique Alberdi, Clara Gómez. Urea versus fractional Er:YAG laser pretreatment of methylene blue photodynamic therapy in the treatment of moderate toenail onychomycosis: short- and medium-term effects. Archives of Dermatological Research. (2022). https://doi.org/10.1007/s00403-022-02448-7

AUTHORS

2 · 2 CENTRES

Enrique Alberdi, Clara Gómez

1Private Clinic of Dr. Alberdi, Aviador Zorita 25, 28020 Madrid, Spain
2Institute of Physical Chemistry Rocasolano, Spanish National Research Council, CSIC, C/ Serrano 119, 28006 Madrid, Spain