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Laser treatment of onychomycosis due to Neoscytalidium dimidiatum: An open prospective study
Andreia Pizarro Leverone1, Dávson Aguilar Guimarães2, Andréa Reis Bernardes-Engemann1,2
1Dermatology Department, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
Abstract:
Conventional systemic and topical treatments have proven ineffective for the treatment of onychomycosis caused by Neoscytalidium dimidiatum. Our aim was to evaluate the effectiveness and safety of laser monotherapy for the treatment of onychomycosis caused by this pathogen. Patients with clinical onychomycosis of the toenails and positive results both on direct mycological examination and N. dimidiatum culture underwent four 1064 nm Nd:YAG laser sessions with 6-week intervals between sessions. Participants were monitored by clinical examination supported by dermoscopy, measurement of diseased nail and the onychomycosis severity index (OSI), and by mycological examination for 12 months after completion of treatment. Treatment outcome was based on clinical and laboratory criteria and was divided in complete or partial cure, clinical improvement, treatment failure and relapse. No patient had complete or partial cure at any time during the study. Clinical improvement was observed in 40.6% of the patients at the end of the laser sessions; however, it did not persist during the follow-up. Treatment failure was observed in 64.7% of the patients at the end of 12 month follow-up period. Direct microscopy and culture results remained positive in most patients. Adverse events, in addition to treatment-related pain, were observed and considered severe in one case. The 1064 nm Nd:YAG laser was not able to cure onychomycosis caused by N. dimidiatum but temporarily improved the clinical appearance of the nail; however, adverse events may occur.
Insights
Nd:YAG laser therapy did not cure toenail fungus caused by Neoscytalidium dimidiatum. While some patients showed temporary clinical improvement, most experienced treatment failure, with persistent positive mycological results and potential adverse events.
Area of Science:
- Dermatology
- Mycology
- Laser Medicine
Background:
- Onychomycosis, a fungal nail infection, is challenging to treat.
- Neoscytalidium dimidiatum is a difficult-to-treat pathogen causing onychomycosis.
- Conventional treatments often lack efficacy for this specific pathogen.
Purpose of the Study:
- To assess the efficacy and safety of 1064 nm Nd:YAG laser monotherapy.
- To evaluate laser treatment for onychomycosis caused by Neoscytalidium dimidiatum.
- To determine long-term outcomes and adverse events associated with laser therapy.
Main Methods:
- Four sessions of 1064 nm Nd:YAG laser treatment were administered at 6-week intervals.
- Patients with confirmed N. dimidiatum onychomycosis were included.
- Clinical, dermoscopic, and mycological assessments were performed for 12 months post-treatment.
Main Results:
- No complete or partial cure was achieved in any patient.
- Temporary clinical improvement was noted in 40.6% of patients post-treatment, but this was not sustained.
- Treatment failure occurred in 64.7% of patients at 12 months, with most remaining mycologically positive.
- Adverse events, including pain, were reported, with one severe case.
Conclusions:
- 1064 nm Nd:YAG laser monotherapy is ineffective for curing onychomycosis caused by Neoscytalidium dimidiatum.
- The laser treatment offers only transient clinical improvement and carries a risk of adverse events.
- Alternative or combination therapies may be necessary for effective management of this infection.
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