Combination of toenail thinning and photodynamic therapy in distal and lateral subungual onychomycosis treatment: A case report.

Onychomycosis is the most common nail disease. There are various treatments available, the majority of which are topical and systemic therapies. However, the poor nail penetration, systemic side effects and the poor compliance of the patients lead to limited efficacy. Photodynamic therapy may be an option. Yet, the penetration of photosensitizer into the nail plate needs to be improved. Here, we report a case of onychomycosis successfully treated with 20 % 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT). Toenail thinning with a common nail file was given before PDT. This suggest that thinning toenails, combining with topical ALA-PDT may be an effective, feasible, and safe alternative for the treatment of onychomycosis, especially for cases recalcitrant or inappropriate to other conventional therapies.