The effects of CO₂ laser and topical agent combination therapy for onychomycosis: A meta-analysis

The routine options for onychomycosis are oral, topical, and device-based therapies which are often limited in terms of efficacy and unsatisfactory side effects. Topical agents such as luliconazole, tioconazole, terbinafine, and tazarotene can be more effective when combined with laser therapies. Our aim was to compare the efficacy and satisfaction rates of CO₂ laser therapy with topical agents in patients with onychomycosis. PubMed, the Cochrane Library, Embase, and Ovid databases were searched to identify randomized controlled trials (RCTs) evaluating the effects of combined therapies. Selected study data were analyzed for differences expressed as odds ratio (OR) and relative ratio (RR) with 95% confidence intervals (CI) for dichotomous outcomes. Efficacy and satisfaction outcomes were assessed using quantitative methods. Our investigations showed that combined CO₂ laser and topical treatments significantly increased efficacy 5.38-fold when compared with topical agents alone (OR 5.38; 95% CI; 3.20-9.04; p < 0.00001), with low heterogeneity observed among studies (I²  = 38%). Mycological clearance comparison rates were also improved by combined treatments. The higher satisfaction of the combined group was assessed by pooled effect (OR 4.56; 95% CI; 2.78-7.49; p < 0.00001). Our evidence suggests combined therapy may exert positive effects and satisfactory safety for patients with moderate to severe onychomycosis, however, optimal combination options and appropriate dosages require more comprehensive RCTs.