Fractional CO₂ Laser Plus Topical Tioconazole 28% versus Topical Tioconazole 28% Alone in the Treatment of Onychomycosis

Abstract

Background: Onychomycosis is a chronic fungal infection of the nail unit. The therapeutic options include oral antifungals as terbinafine,  pulse itraconazole, fluconazole and voriconazole. Various laser systems have been tried for resistant cases to improve the results of  treatment as carbon dioxide (CO₂) and Nd:YAG lasers.

Objective: Compare between two treatment methods; combined therapy of  fractional CO₂ laser (FCO₂L) plus topical tioconazole 28% nail solution versus topical tioconazole 28% nail solution alone in the same  patient with fingernails onychomycosis.

Methods: This was prospective comparative interventional study conducted on 20 patients with  two or more affected fingernails. The degree of affection of the studied nails was assessed clinically by onychomycosis severity index  (OSI) and was confirmed by KOH and mycological culture. The studied nails were categorized into two corresponding groups; group (A),  fingernails were treated with combined therapy in the form of 4-6 fractional CO₂ laser sessions four weeks apart plus topical tioconazole  28% twice daily for six months, group (B), fingernails were treated with topical tioconazole 28% alone twice daily for six months.

Results:  A high statistically significant improvement was reported among patients treated with combined therapy than those who treated with  antifungal only. The CO₂ laser plus topical tioconazole solution yielded significantly higher percentage of improvement for  onychomycosis.

Conclusion: Both combined therapy and local therapy reported safe and promising outcomes. However combined   therapy was associated with better improvement and local therapy was associated with minimal adverse events.