Diode Laser for Treatment of Onychomycosis

Onychomycosis is a common infection of the nail and affects approximately 6% of the adult population. It affects immunocompromised individuals (ie HIV positive patients), smokers and patients with psoriasis, peripheral vascular diseases or patients having suffered a traumatic to the nails. Pathogenic agents causing the occurrence of onychomycosis are numerous and varied different forms of Trichophyton, Epidermophyton floccosum, but also mold and yeast. 

The treatment of onychomycosis is hard because the infection is located in the fingernail, over an area difficult to achieve. Complete removal of symptoms is slow and may take more than one year. Several oral and topical therapies have been used in the past to treat onychomycosis. Topical therapies, such as potassium permanganate, has been the main method of treatment, until systemic antifungal new treatments have been developed. 
These antifungal therapies, such as itraconazole and terbinafine, have not only modest clinical success, but may also have common side effects, such as headaches, gastrointestinal and cutaneous disorders. 
A new concept for non-invasive treatment of onychomycosis is irradiation in a specific area with a laser beam, whose wavelength is absorbed by the pathogens. The absorbed energy is converted into heat, and the temperature increase which follows heat disables the pathogenic microorganisms, without damaging the surrounding tissue. 
The specific wavelength used by 980nm diode laser has the effect of disabling the parasitic organism. Moreover, the duration of pulses applied, about ms, is less than the thermal relaxation of the skin (about 10 ms). That will allow the containment of thermal absorbed energy, in order to make the treatment painless. Such a device is used together with an optical fiber and a handpiece, issuing a beam of a 6mm diameter in order to maximize the processing performance. 

The protocol for treatment of onychomycosis consists of three treatments performed the day 1, day of the first treatment, followed by two additional treatments after 30 and 60 days. During each treatment about 700J/cm2 are released by the pulses with a peak power of 30 W and a duration of 2 msec. The success rate is approximately 70%. 

Benefits of this technology are numerous: 
- Infrared radiation has no risk of teratogenicity, unlike the ultraviolet; 
- No medications are required for the therapy, unlike photodynamic therapy (PDT - Photodynamic Therapy); 
- No toxic fumes related to the laser ablation of typical pulse lasers, such as Nd: YAG laser; 
- No side effects or complications; 
- The action that the laser performs acts on bacteria and fungus without damaging healthy tissue, as the temperature at which the nail is brought with treatment parameters tested, brings the temperature to about 42 ° C , a temperature required to kill bacteria or fungi, without affecting healthy tissue; 
- The treatment is painless.

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