Conventional Photodynamic Therapy versus Fractional CO2 Laser Assisted Photodynamic Therapy in Treatment of Onychomycosis

Abstract

Background: Onychomycosis is a common persistent infection of the nail unit by fungi either dermatophytes, yeasts or nondermatophyte molds (NDMs). It is classified clinically to distal and lateral subungual onychomycosis (DLSO), superficial white onychomycosis (SWO), proximal subungual onychomycosis (PSO), candidal onychomycosis, endonyx onychomycosis and total dystrophic onychomycosis (TDO). Onychomycosis is commonly confirmed by clinical examination side by side with regular diagnostic techniques such as direct microscopy and fungal culture, which are considered the golden are considered the golden standards of diagnosis. Aim of the Work: to evaluate two PDT approaches in the treatment of onychomycosis. The study will compare the effect of PDT using conventional method versus fractional CO2 assisted PDT for achievement of a clinical and mycological cure in cases of onychomycosis. Patients and Methods: we conducted a right-left controlled study, on 21 patients with at least 2 toenails onychomycosis in the same patient. These patients were recruited from outpatient clinic of dermatology department at Ain Shams University Hospitals. The study was conducted during the period from December 2016 till June 2017. Twenty-one patients (4 males and 17 females) with clinical signs of toenail onychomycosis were enrolled in the study. The diagnosis was confirmed via laboratory studies. Results: in our study, we found that Aspergillus species were the most common causative organisms of OM followed by and this is possibly because the non NDMs are more frequent in tropical and subtropical areas with a hot and humid climate. Conventional PDT and fractional CO2-assisted PDT have an antifungal activity as manifest by a mycological cure rate of 57.1% and 76.2% in OM cases respectively. Fractional CO2- assisted PDT was superior to conventional PDT as regard the clinical improvement in nail appearance and patient satisfaction. Conclusion: non-dermatophyte molds are important and common pathogens in toenail onychomycosis. Aspergillus species play an important role as pathogens for toenail onychomycosis in Egypt.