Combination of Q-switched 1,064 and 532 nm Nd: YAG laser in the treatment of toenail onychomycosis: a pilot study

Previous studies have demonstrated that laser-based therapies can effectively improve the appearance of nails affected by onychomycosis, offering a high safety margin, making them suitable for patients in whom systemic antifungal agents are contraindicated. Building on earlier studies, a pilot clinical trial was designed to assess the effectiveness of a Q-switched Nd: YAG laser using dual wavelengths (1,064 nm and 532 nm) for the treatment of toenail onychomycosis. This study involved 15 participants with distal lateral subungual onychomycosis (DLSO) of the big toe caused by dermatophytes. Each laser session included two applications of 1,064 Nd: YAG laser at 600 mJ/pulse, 20 ns, 2 Hz, for 1 min, separated by a 1-minute pause. After a 2-minute rest, the 532 nm laser was applied in a similar manner using the same parameters. Treatments were administered weekly over eight weeks. Progress was monitored using the Onychomycosis Severity Index (OSI), based on direct clinical examination and photographs taken at baseline, during each session, and at follow-up visits. Mycological clearance was assessed via PAS-stained histopathology and fungal culture. Pain during treatment was evaluated using a visual analogue scale (VAS), and any side effects were recorded. At week 43, both mycological cure rate (MCR) and complete cure rate (CCR) were 33.3% (5 out 15 patients). The laser therapy was well-tolerated, with no reported adverse effects. Pain scores averaged 6.5 ± 0.5 during the 1,064 nm application and 7.8 ± 0.5 during the 532 nm application. Despite some discomfort, patient satisfaction remained high. The dual-wavelength Q-switched Nd: YAG laser appears to be a promising treatment option for mild onychomycosis, although its effectiveness is limited in severe onychomycosis. Further research is needed to optimize laser parameters, session frequency, and follow-up duration to maximize therapeutic outcomes.