Role of Q-switched neodymium-doped yttrium aluminum garnet laser in combination with fractional carbon dioxide laser for the treatment of onychomycosis

Objectives: Our aim was to evaluate the role and efficacy of Q-switched neodymium-doped yttrium aluminum garnet (Nd: YAG) combined with fractional carbon dioxide (CO 2 ) laser for the treatment of onychomycosis without administration of oral antifungals. Materials and Methods: Twenty-five patients with onychomycosis and positive fungal cultures, who had not been on any oral antifungal for at least six months, were included in our study. The patients were treated with monthly sessions combining 1,064 nm Q-switched Nd: YAG laser, ms quasi mode, and fractional CO 2 laser for six months, along with a topical antifungal. The visual analog score was calculated according to patient observation for cosmetic clearance after three and six sessions, and three and six months after completion of the laser sessions. The onychomycosis severity index (OSI) was used by the clinician at the beginning and the end of the study as a tool to measure the treatment outcome. Fungal cultures were done six months after the completion of sessions to evaluate fungal clearance. Results: Twenty of the 25 enrolled patients completed the study. Of these, 5 (25%) patients had complete cosmetic clearance after six sessions, and 15 (75%) patients had complete clearance at three months after completion of the sessions, which was maintained at six months. On comparing the OSI score calculated at the beginning of the laser therapy and six months after completion of laser sessions, a significant response to treatment ( P < 0.001) was seen. In total, 17 (85%) patients had negative fungal cultures six months after completion of sessions proving no relapse till six months. Conclusion: Our study concludes that Q-switched Nd: YAG in combination with fractional CO 2 laser is beneficial in the treatment of onychomycosis by destruction of fungal elements and increasing the topical drug delivery. These lasers are commonly available in dermatology practice and can be combined with oral antifungals to reduce the treatment duration.