Efficacy of Intralesional Platelet-Rich Plasma in Treatment of Fingernail Onychomycosis: A Randomized Controlled Trial

Introduction: Emerging evidence suggests that platelet-rich plasma (PRP) has an antifungal role. Objectives: To investigate the efficacy of intralesional PRP in the treatment of fingernail onychomycosis. Patients and Methods: Patients with fingernail onychomycosis were randomized to receive oral terbinafine 250 mg daily for three months, six sessions of intralesional PRP, or both (PRP + terbinafine). Primary outcome of the study was change in onychomycosis severity index (OSI) at the end of follow-up. Two blinded investigators (investigators A and B) assessed the outcomes. The assessment was carried out per affected nail rather than per affected patient. Results: Twenty, 18, and 23 patients were included in the terbinafine, PRP, and terbinafine + PRP groups, respectively, with 40, 51, and 50 nails treated in each respective group. OSI was comparable among study groups according to investigator A (terbinafine: 4 [IQRs: 4, 9], PRP: 6 [IQRs: 2, 12], PRP + terbinafine: 5 [IQRs: 3, 8]; p>0.9) and investigator B (terbinafine: 4 [IQRs: 3, 10], PRP: 6 [IQRs: 4, 10], PRP + terbinafine: 6 [IQRs: 3, 12]; P>0.9). Similarly, mycological cure (terbinafine: 20%, PRP: 35%, PRP + terbinafine: 34%; P=0.23), clinical cure (terbinafine: 23%, PRP: 27%, PRP + terbinafine: 32%; P=0.61), and complete cure (terbinafine: 20%, PRP: 27%, PRP + terbinafine: 28%; P=0.64) were comparable. Conclusions: Six sessions of intralesional PRP were effective in treating fingernail onychomycosis, making it a potential viable alternative for patients who may not respond well to oral antifungal medications or who experience adverse effects from these drugs.