PEER-REVIEW | LITERATURE REVIEW |
but another recent study did not find any inhibitory effect with various laser fluences 24
. . Nevertheless,
some studies demonstrated an effectiveness of lasers in vivo 25,26
Two studies with a long pulse Nd: YAG laser have been
reported. In the first, 194 nails with onychomycosis confirmed by direct and culture examination were treated 27
and 413 nails in the second 28 were fluence of 35 Ð 40 J/cm2 . Parameters used , spot size 4 mm, pulse
duration 35 ms, pulse rate 1 Hz, three passes, four sessions with an interval of 1 week; cold air-cooling was necessary during the treatment. At 6 months, 98.8% of patients had mycological clearance. No side-effects or complications were reported. Another study proposed the use of a Nd: YAG laser (1064 nm) with a short pulse duration at 0.65 ms that allows damage to underlying tissue to be reduced 29
.
Parameters used were spot size of 2 mm and a fluence of 223 J/cm2
; the mean time of treatment for each affected
nail was 45 seconds; only eight patients were treated with 2–3 sessions with intervals of 3 weeks. Mycological cure was obtained in half of the patients after two sessions, and seven out of the eight patients showed mycological cure after the last session. A recent study used a combined approach with
atraumatic avulsion of infected nail material, 2–4 passes of Nd: YAG treatment at 200 mJ/cm2 cream 30
. The few studies available are not controlled studies
and longer follow-ups are needed to say whether the results are a temporary inhibition of fungal growth or a destruction of fungus. The best device is still to be determined with regard to the number of treatments and the intervals between them. A recent survey not only lists the pertinent publications, but also many studies currently being conducted 31,32
. Disruption of the nail plate surface with lasers as well
as burning holes may enhance the permeability of the nail for drug penetration into and through the nail 33
technique has also been used to improve topical onychomycosis therapy 34
. . This
Subungual haematomas and various tumour-like lesions Subungual haematoma is a painful sequela of an acute trauma and decompression is the immediate
Figure 2 Before and after surgery for ingrown toenail , and antimycotic
Nail psoriasis Nail psoriasis is common and observed in approximately 50% of all psoriatics; however, the life-long risk to develop nail changes is estimated at 90% 35
. Psoriatic nail
alterations are notoriously difficult to treat, although they are said to respond to systemic treatment when this is successful. Three studies of laser treatment have been published.
In the first, 61 nails were treated with photodynamic therapy (PDT) and 60 nails treated with a pulsed dye laser (PDL), pulse duration 6 ms, 9 J/cm2
. A Nail psoriasis
is common and observed in approximately 50% of all psoriatics; however, the life-long risk to
develop nail changes is estimated at 90%.
cm2
decrease in the nail psoriasis severity index (NAPSI) score was observed with both treatments and in both nail matrix and nail bed involvement. No statistical differences were observed between PDT and PDL (at baseline P = 0.632; at 3 months P = 0.084; and at 6 months P = 0.535), and between nail matrix and nail bed NAPSI scores (P = 0.423 and P = 0.853, respectively) 36
. The second trial used , beam diameter was 7 mm 37
595 nm PDL once per month for 3 months. Pulse duration was 1.5 ms, laser energy 8 Ð 10 J/ . Despite the considerably
shorter pulses, there was a statistically significant improvement of the NAPSI scores, particularly
regard to onycholysis and subungual hyperkeratosis. The most recent study compared long and short pulse
PDL treatment. The results were obtained with variable pulse durations and fluences ® 6 ms pulses with 9 J/cm2 in 40 nails and 0.45 ms pulse duration with 6 J/cm2
in 39
nails were virtually identical; the only difference was statistically significant lower pain levels in the shorter pulse group 38
. Therefore, the concept that angiogenesis is
a major factor in the activity of psoriatic lesions appears to be supported by coagulating blood vessels with the dye laser.
with
Ingrown hallux nail before surgery 92 ❚
3 months after surgery March 2013 |
prime-journal.com
The toe 1 year after surgery
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