Q 开关 Nd:YAG 激光与伊曲康唑脉冲疗法治疗甲真菌病：临床皮肤镜和真菌学研究。
Q-switched Nd:YAG laser versus itraconazole pulse therapy in treatment of onychomycosis: A clinical dermoscopic and mycologic study.
机构信息
Department of Dermatology, STD's and Andrology, Faculty of Medicine, Minia University, Al Minya, Egypt.
出版信息
J Cosmet Dermatol. 2023 Jun;22(6):1757-1763. doi: 10.1111/jocd.15660. Epub 2023 Jan 30.
BACKGROUND
Onychomycosis (OM) represents about 50% of nail disorders. Oral antifungals have proven efficacy in the treatment of onychomycosis but their associated side effects limit their use. Accordingly, there is an increased need for a safe and effective therapy to induce clearance and improve the esthetic appearance of diseased nails.
OBJECTIVE
The current study is an attempt to evaluate and compare the efficacy of Q-Switched Nd:YAG (1064 nm) laser as monotherapy versus pulse itraconazole in the clearance of onychomycosis.
METHODS
In this prospective study, 40 onychomycosis patients were equally divided into two groups: Groups I (laser group) and II (Itraconazole group). Patients of Group I are treated with six biweekly sessions of Q-Switched Nd:YAG (1064 nm) laser. Patients of Group II are treated with itraconazole pulse therapy. The assessment of clearance was rated using the "Onychomycosis Severity Index (OSI)", photographs, dermoscopy, and mycology. All 40 patients were followed up for 3 months after the end of treatment.
RESULTS
Group I's clinical improvement response was a marked improvement in 19 cases and moderate improvement in one case (OSI before treatment was 24.5 and after was 0). A dermoscopic cure occurred in 19 cases. Mycological cure was obtained in 19 cases. Group II's clinical improvement response was marked in 15 and moderate in 5 (OSI before treatment was 24 and after was 0). Dermoscopic cure occurred in 15 cases. Mycological cure was obtained in 15 cases. There were no adverse effects. The clinical response, the dermoscopic cure, and the mycological cure were equal in both groups, with no significant difference found between them.
CONCLUSION
Q-Switched Nd:YAG (1064 nm) laser can be used as an effective and safe modality in the clearance of nail onychomycosis, particularly in patients who have a contraindication to or refuse the use of oral antifungals.
背景
甲真菌病（OM）约占指甲疾病的 50%。口服抗真菌药物已被证明在治疗甲真菌病方面有效，但它们的相关副作用限制了它们的使用。因此，人们越来越需要一种安全有效的治疗方法来诱导清除和改善患病指甲的美观。
目的
本研究旨在评估和比较 Q 开关 Nd：YAG（1064nm）激光单独治疗与脉冲伊曲康唑治疗甲真菌病的疗效。
方法
在这项前瞻性研究中，将 40 例甲真菌病患者等分为两组：I 组（激光组）和 II 组（伊曲康唑组）。I 组患者接受 6 次 Q 开关 Nd：YAG（1064nm）激光治疗，每两周一次。II 组患者接受伊曲康唑脉冲治疗。采用“甲真菌病严重指数（OSI）”、照片、皮肤镜和真菌学评估清除率。所有 40 例患者在治疗结束后 3 个月进行随访。
结果
I 组的临床改善反应为 19 例显著改善，1 例中度改善（治疗前 OSI 为 24.5，治疗后为 0）。19 例出现皮肤镜下治愈。19 例获得真菌学治愈。II 组的临床改善反应为 15 例显著改善，5 例中度改善（治疗前 OSI 为 24，治疗后为 0）。15 例出现皮肤镜下治愈。15 例获得真菌学治愈。两组均无不良反应。两组的临床反应、皮肤镜下治愈和真菌学治愈均相等，无显著差异。
结论
Q 开关 Nd：YAG（1064nm）激光可作为一种有效且安全的治疗方法，用于清除指甲甲真菌病，特别是在对口服抗真菌药物有禁忌或拒绝使用的患者中。
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