Utilization of Nd-YAG Laser in Treatment of Onychomycosis in Sudanese Patients

Abstract

This is a quasi experimental study of the effect of utilization of long pulse Nd- YAG laser in the treatment of onychomycosis. Conducted in Khartoum dermatology hospital- laser unit during the period from May 2018 to August 2018. The objective of this study was to study the effect of long pulse Nd- YAG laser in the treatment of onychomycosis. Ten patients were enrolled in the study, with total number of 63 affected nails. All patients were treated with Nd:YAG 1064 nm, fluence was (60-80) J/cm2, pulse duration 5 ms, spot size 3 mm, 1 Hz frequency and 3 passes. A full course of treatment was consisted of four sessions, with one week interval. Treatment outcome were determined by the assessment of clinical improvement, patient satisfaction and mycological results. The study found that, clinical improvement was achieved among fingernails in 7 patients (77.8%) (p value < 0.05), and among toenails in 2 patients (33.3%) (p value > 0.05). On the other hand, mycological clearance achieved in 8 patients (89.9%) with finger nails involvement (p value < 0.05), and 4 patients (66.7%) with toenails involvement (p value < 0.05). the last criteria for assessment was patient satisfaction, which was achieved in 2 patients (33.3%) with fingernails involvement (p value > 0.05) and only one patient (16.7%) with toenail involvement (p value > 0.05). The final clinical response was determined by using the score of three above mentioned criteria; excellent response was achieved in 2 patients (22.2%) among fingernails and 0 patients (0%) among toenails. Good response was achieved in 5 patients (55.6%) among fingernails and 2 patients (33.3%) among toenails. Poor response was achieved in 2 patients (22.2%) among fingernails and 2 patients (33.3%) among toenails. No response was achieved in 0 patients (0%) among fingernails and 2 patients (33.3%) among toenails. Finally, Laser is a safe treatment that may be especially useful in patients with contra indication to systemic antifungals like liver diseases. Further large Randomize Control Trails are needed in order to confirm this results.