Alves Renata de Oliveira, Urzedo Lara Oliveira Ribeiro, de Toledo Priscila Toninatto Alves, Ferreira-Baptista Carla, Ragghianti Matheus Henrique Faccioli, Pereira Thais Cristina, Nunes Larissa Pereira, Alvites Rui Damazio, Nunes Gabriel Pereira
Department of Preventive and Restorative Dentistry, Araçatuba School of Dentistry, São Paulo State University - UNESP, Araçatuba, SP, Brazil.
Department of Operative Dentistry, Endodontics and Dental Materials, São Paulo University - USP, Bauru School of Dentistry, Bauru, SP, Brazil.
Photodiagnosis Photodyn Ther. 2025 Aug;54:104640. doi: 10.1016/j.pdpdt.2025.104640. Epub 2025 May 17.
Onychomycosis is a prevalent fungal nail infection often resistant to conventional antifungal therapies. Antimicrobial photodynamic therapy (aPDT) has emerged as a promising alternative, though its efficacy remains under investigation. This systematic review aimed to assess the effectiveness of aPDT in managing onychomycosis.
Conducted according to PRISMA guidelines and registered in PROSPERO (CRD42024520247), this review included clinical trials evaluating the antimicrobial efficacy of aPDT for onychomycosis. Searches were performed in PubMed, Scopus, Web of Science, Embase, Cochrane Library, ClinicalTrials.gov, and gray literature. Two reviewers independently screened, selected, and extracted data on study characteristics. Risk of bias was assessed using the Cochrane tool and Newcastle-Ottawa scale; certainty of evidence was evaluated using GRADE.
Eighteen studies involving 591 participants (mean age: 54.2 years) met inclusion criteria. The most common light source was diode laser (450-700 nm), and photosensitizers included methylene blue, aminolevulinic acid, and methyl-5-aminolevulinate. aPDT significantly reduced onychomycosis severity (30-90 % OSI reduction) and achieved mycological cure rates up to 100 % when combined with fractional CO laser. Clinical cure rates ranged from 20 % to 80 %, with notable improvements in nail appearance. Histological and microbiological analyses confirmed fungal reduction, and patient satisfaction was generally high. Overall, studies showed low risk of bias. The certainty of evidence was moderate for randomized controlled trials and low for non-randomized trials.
aPDT demonstrates promising potential in onychomycosis management, showing clinical and microbiological efficacy. However, variability in protocols and outcomes requires further standardized clinical trials to establish optimal treatment parameters.
甲癣是一种常见的真菌性指甲感染，通常对传统抗真菌治疗有抗性。抗菌光动力疗法（aPDT）已成为一种有前景的替代方法，但其疗效仍在研究中。本系统评价旨在评估aPDT治疗甲癣的有效性。
根据PRISMA指南进行，并在PROSPERO（CRD42024520247）注册，本评价纳入了评估aPDT治疗甲癣抗菌疗效的临床试验。在PubMed、Scopus、科学网、Embase、Cochrane图书馆、ClinicalTrials.gov和灰色文献中进行检索。两名评价者独立筛选、选择并提取关于研究特征的数据。使用Cochrane工具和纽卡斯尔-渥太华量表评估偏倚风险；使用GRADE评估证据的确定性。
18项研究涉及591名参与者（平均年龄：54.2岁）符合纳入标准。最常见的光源是二极管激光（450 - 700 nm），光敏剂包括亚甲蓝、氨基乙酰丙酸和甲基-5-氨基乙酰丙酸。aPDT显著降低了甲癣严重程度（OSI降低30 - 90%），与分次CO激光联合使用时真菌学治愈率高达100%。临床治愈率为20%至80%，指甲外观有显著改善。组织学和微生物学分析证实真菌减少，患者总体满意度较高。总体而言，研究显示偏倚风险较低。随机对照试验的证据确定性为中等，非随机试验的证据确定性为低。
aPDT在甲癣治疗中显示出有前景的潜力，具有临床和微生物学疗效。然而，方案和结果的变异性需要进一步的标准化临床试验来确定最佳治疗参数。
