Efficacy of Itraconazole Pulse Therapy Versus Q-Switched Nd-YAG Laser Versus Combination of Both in the Treatment of Onychomycosis-A Single-Blind Randomized Control Trial.

BACKGROUND

Onychomycosis is a fungal infection of the nails. Oral itraconazole inhibits lanosterol-14α demethylase, impairing fungal cell membrane synthesis. The 1064 nm Q-switched Nd:YAG laser produces photothermolytic and photomechanical effects on fungi. Since both act via different mechanisms, their combination may offer additive benefits.

OBJECTIVES

To compare the efficacy of oral itraconazole pulse therapy, 1064 nm Q-switched Nd:YAG laser therapy, and their combination in treating onychomycosis.

METHODS

Ninety Potassium hydroxide(KOH) mount- and culture-positive patients were randomized into 3 groups: itraconazole pulse (Group A), laser therapy (Group B), or combination therapy (Group C). Patients were followed for 9 months with 3-month interval assessments. Onychomycosis Severity Index (OSI), KOH mount, and culture were evaluated at each visit. Complete cure, clinical and mycological cure, effectiveness, and failure rates were compared.

RESULTS

All groups showed significant OSI reduction from baseline (P < .001), with no significant intergroup differences (P > .05). Clinical cure occurred in 20 patients (74.07%) in Group A, 20 (74.07%) in Group B, and 20 (80%) in Group C. No relapse occurred during follow-up. KOH and culture results did not differ significantly among groups.

CONCLUSION

Laser therapy, alone or with itraconazole, was as effective as itraconazole pulse therapy. Given its efficacy and absence of systemic side effects, the Nd:YAG laser offers a safe alternative in managing onychomycosis.