Treatment of onychomycosis using a 1064-nm diode laser with or without topical antifungal therapy: a single-center, retrospective analysis in 56 patients.

BACKGROUND: Currently available treatment options for onychomycosis such as topical and systemic antifungals are often of limited efficacy, difficult to administer or associated with relevant side effects. Non-ablative laser therapy is proposed to represent a safe alternative without the disadvantages of drugs. Yet, to date, the efficacy of laser therapy for onychomycosis is discussed controversially. Against this background, we performed a systematic retrospective analysis of our clinical experience of 4 years of onychomycosis treatment applying a long-pulsed 1.064-nm diode laser. METHODS: We retrospectively evaluated the records of 56 patients with microscopic and culturally proven onychomycosis affecting a toenail of the hallux and other toes, who had been treated with a long-pulsed 1.064-nm diode laser (FOX, A.C.R. Laser GmbH, Nuremberg) during the time period of July 2013-December 2016 with or without concomitant topical antifungals. Thereof, 27 patients received laser treatment and 29 patients received laser treatment in combination with local antifungals. We conducted a mean of 3.9 laser treatments at 2-6-week intervals. The primary endpoint of our analysis was clinical improvement; secondary endpoints were complete remission of fungal pathogens in fungal culture and in microscopy. RESULTS: Clinical improvement was achieved in 56% of patients treated with laser only after a mean of 4.5 treatments and in 69% of patients treated with laser in combination with topical antifungals after a mean of 3.6 treatments. Cultural healing was detected in 63% of patients treated with laser only after a mean of 5.4 treatments, vs. 86% of patients treated with laser and concomitant topical antifungals after a mean of 4.8 treatments. Microscopic healing (complete healing) with the absence of fungal pathogens was achieved in 11% of patients after a mean of 4.7 treatments with laser only, vs. 21% of patients treated with laser and concomitant topical antifungals after a mean of 4 treatments. No relevant adverse effects were observed. CONCLUSIONS: The 1.064-nm diode laser is an effective and safe option for the treatment of onychomycosis. Of note, the combination with topical antifungals will increase overall treatment efficacy and reduce the time to healing. Particularly, patients with contraindications against systemic antifungals may benefit from this multimodal therapeutic approach. Our data, moreover, suggest that treatment efficacy is positively correlated with the total number of laser treatments.

Pigmented purpuric eruptions of childhood: a series of cases and review of literature.

Pigmented purpuric eruptions comprise a group of benign dermatoses that are characterized clinically by pinpoint petechiae and purpura on a hyperpigmented base and histologically by capillaritis. The etiology of this group of disorders is unknown, although aberrant cell-mediated immunity has been proposed. Pigmented purpuric eruptions are well characterized in the pediatric population. In this case series we present three children with these disorders and review the clinical subtypes of pigmented purpuric eruptions that have been described in the literature.

Efficacy and safety of treatment modalities for psoriasis.

Although there is no cure for psoriasis, a variety of treatments are available to reduce the severity of symptoms and lessen their impact on the patient's quality of life. For patients with less than 20% body surface involvement, topical therapy is the most appropriate choice for initial treatment. Commonly used topical therapies include corticosteroids; calcipotriene, a vitamin D analogue; tazarotene, the first retinoid to be approved for the treatment of psoriasis; and anthralin. Each of these treatments is effective in mild to moderate psoriasis, but each is also associated with varying degrees of safety and tolerability concerns. For patients with more severe, recalcitrant, or extensive psoriasis, phototherapy and systemic therapies are available. These therapies are more effective than topical therapy, but are also associated with significant cutaneous and systemic adverse effects. Phototherapy, alone or in combination with coal tar or psoralen, is very effective in the treatment of moderate to severe psoriasis, but can lead to erythema and pruritus acutely, and long-term problems such as wrinkling, solar elastosis, and an increased risk of skin cancer. Systemic therapies such as acitretin, methotrexate, cyclosporine, hydroxyurea, and thioguanine are also very effective in the treatment of moderate to severe psoriasis, but are all associated with significant systemic toxicity, which requires that patients be monitored carefully. Ultimately, treatment selection for each patient must take into account both the patient's disease severity and expectations for improvement, as well as the risk-benefit ratio associated with each potential therapy.