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Efficacy of Intralesional Platelet-Rich Plasma in Treatment of Fingernail Onychomycosis: A Randomized Controlled
Reem Elhaddad Ali1, Mohammed Abu El-Hamd1, Amr Abdelhamed1
1Dermatology, Venereology and Andrology Department, Faculty of Medicine, Sohag University, Sohag, Egypt.
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.
Insights
Platelet-rich plasma (PRP) shows promise for treating fingernail onychomycosis. Intralesional PRP offers a viable alternative for patients unresponsive to or intolerant of oral antifungal treatments.
Area of Science:
- Dermatology
- Mycology
- Regenerative Medicine
Background:
- Emerging evidence suggests platelet-rich plasma (PRP) possesses antifungal properties.
- Fingernail onychomycosis presents a therapeutic challenge, with varying responses to conventional treatments.
Purpose of the Study:
- To evaluate the effectiveness of intralesional platelet-rich plasma (PRP) for treating fingernail onychomycosis.
- To compare PRP treatment with oral terbinafine and a combination therapy.
Main Methods:
- A randomized study involving patients with fingernail onychomycosis.
- Treatment groups included oral terbinafine, intralesional PRP, and combination therapy (PRP + terbinafine).
- Outcomes were assessed by two blinded investigators using the Onychomycosis Severity Index (OSI), mycological cure, clinical cure, and complete cure rates.
Main Results:
- Onychomycosis Severity Index (OSI) scores were comparable across all treatment groups (terbinafine, PRP, and PRP + terbinafine) as assessed by both investigators.
- Mycological cure rates were 20% for terbinafine, 35% for PRP, and 34% for PRP + terbinafine.
- Clinical and complete cure rates also showed no significant differences between the groups.
Conclusions:
- Six sessions of intralesional PRP demonstrated efficacy in treating fingernail onychomycosis.
- PRP serves as a potential alternative for patients with limited response or adverse effects from oral antifungal medications.
- Further research may explore PRP's role in managing onychomycosis, especially in specific patient populations.
