Distal and lateral toenail onychomycosis caused by Trichophyton rubrum: treatment with photodynamic therapy based on methylene blue dye

The study showed the effectiveness of photodynamic therapy based on methylene blue totreat severe distal and lateral subungual toenail onychomycosis. 22 patients weredivided into two groups: group A consisting of 11 patients with severe toenailonychomycosis and group B consisting of 11 patients with mild-to-moderate toenailonychomycosis. All patients had onychomycosis caused by Trichophyton rubrum. Thepatients were treated with sessions of 2% methylene blue aqueous solution irradiatedwith light emission diode device with 630 nm and 36 J/cm2 biweekly for six months.The clinical response was significantly better in patients with mild-to-moderate(100%) onychomycosis compared with patients with severe onychomycosis (63.6%).     

Endonyx toenail onychomycosis caused by Trichophyton rubrum: treatment with photodynamic therapy based on methylene blue dye

This study shows the effectiveness of photodynamic therapy based on methylene bluedye for the treatment of endonyx toenail onychomycosis. Four patients with endonyxonychomycosis caused by Trichophyton rubrum were treated with 2% methylene blueaqueous solution irradiated with light emission diode at 630 nm and an energy densityof 36 J/cm2 for 6 months at 2-week intervals. The preliminary study showed theeffectiveness of this therapy in the treatment of endonyx onychomycosis, and alsoindicated that the disease can be caused by T. rubrum.     

Using 80% trichloroacetic acid in the treatment of ingrown toenails

BACKGROUND

Ingrown nails are a very common problem. There are different stages of disease and diverse therapeutic options. Phenol and sodium hydroxide are commonly used agents for chemical matricectomy but both frequently entail excessive healing times.

OBJECTIVE

This prospective study aimed mainly to evaluate the efficacy of partial nail avulsion and selective chemical cauterization of the matrix using 80% TCA in the treatment of the ingrowing nail.

METHODS

One-hundred-and-thirty-three patients with 197 ingrown toenails were included in this study. Preoperatively, we tried to find predisposing factors to the disease. In the postoperative period, patients were evaluated for potential complications at days 3, 30, 180, 270 and 360. Pain was measured before surgery, as well as 24 hours and 72 hours after surgery.

RESULTS

There were only 3 cases (out of 197) of ingrown nail recurrence. Preoperatively, we found the presence of drainage in 82% of patients, which, following the first visit after surgery, was reduced to 19%. Persistent granulation tissue was found in 3% of the patients (versus 75% prior to surgery). The most frequent predisposing factors for the ingrown nail were excessive trimming of the lateral nail plate (63%), plantar hyperhidrosis (58%) and heavy nail folds (39%). Pain was substantially reduced after surgery.

CONCLUSION

It is assumed that chemical procedures for the ingrown toenail are associated with delayed healing times but our results demonstrated quick recovery. Using 80% TCA for selective matricectomy in the ingrown toenail is an effective, quick and easy method.     

Dermoscopy and Onychomycosis: guided nail abrasion for mycological samples

Mycological examination is still the cornerstone for the diagnosis ofonychomycosis for many dermatologists, but sampling technique interferes onits sensitivity and specificity. Nail abrasion may be used to reach themost proximal part of the lesion and can be easily accomplished with anelectric abrasor. We suggest nail plate dermoscopy to identify the bestlocation for localized abrasion to obtain adequate samples for mycologicalexamination.     

Consensus on melanonychia nail plate dermoscopy

This statement, focused on melanonychia and nail plate dermoscopy, is intended to guide medical professionals working with melanonychia and to assist choosing appropriate management for melanonychia patients. The International Study Group on Melanonychia was founded in 2007 and currently has 30 members, including nail experts and dermatopathologists with special expertise in nails. The need for common definitions of nail plate dermoscopy was addressed during the Second Meeting of this Group held in February 2008. Prior to this meeting and to date (2010) there have been no evidence-based guidelines on the use of dermoscopy in the management of nail pigmentation.     

Efficacy of combination therapy with efinaconazole 10% solution and 1064 nm Nd:YAG laser for treatment of toenail onychomycosis

Background: Onychomycosis is a common but difficult to treat nail disorder. Treatment strategies thus far have included oral and topical antifungals, surgical treatment and recently lasers have emerged as a therapeutic modality.

Objective: The objective of this study was to assess whether efinaconazole together with laser would result in greater clinical and mycologic cure and lower rate of relapse compared to efinaconazole alone.

Methods: Thirty subjects were randomized to either self-apply efinaconazole 10% once daily for 48 weeks, or follow the same treatment plan but also receive six treatments with a 1064 nm Nd: YAG laser every 4 weeks. The primary endpoint was to assess the proportion of subjects who achieved complete cure at week 52.

Results: The combination therapy group showed significantly quicker mycological cure at the 48- and 52-week follow-up.

Conclusion: Both efinaconazole and combination with laser were efficacious treatment, but the combination therapy leads to quicker resolution with fewer rate of relapse.     

The use of the Er:YAG 2940nm laser associated with amorolfine lacquer in the treatment of onychomycosis

Onychomycosis is a common disease, accounting for up to 50% of all ungual pathologies. We have been developing a clinical trial (ClinicalTrials.gov: {"type":"clinical-trial","attrs":{"text":"NCT01528813","term_id":"NCT01528813"}}NCT01528813) using a 2940nm Er:YAG laser to fractionally ablate human nails in vivo, aiming to increase topical amorolfine lacquer delivery to the nail unit, increasing the efficacy of topical treatment of distal and lateral subungual onychomycosis. Partial results have shown an increase in areas of nail plate free of disease. We believe that ablative lasers can increase the efficacy of topical onychomycosis treatment.     

Fractional CO2 laser plus topical antifungal versus fractional CO2 laser versus topical antifungal in the treatment of onychomycosis

Onychomycosis is an important medical disorder affecting both health and quality of life of patients. This study was done to compare the efficacy of CO₂ laser in combination with topical tioconazole versus CO₂ laser only versus topical tioconazole alone in onychomycosis. A total of 120 patients with onychomycosis were randomly assigned to three groups. Group A patients were treated with fractional CO₂ laser followed by topical tioconazole 28% for five sessions with 3 weeks interval. Group B patients were treated with only fractional CO₂ laser for five sessions with 3 weeks interval. Group C patients were treated with only topical tioconazole 28% for 16 weeks. The clinical effect, KOH examination, and culture for the affected nails in the three groups were analyzed. One month after the last session, regarding clinical response, 55% showed complete clinical improvement in Group A versus 30% in Group B versus 25% in Group C with a significant difference in between. There was a significant difference between the three studied groups as regard KOH test and culture after treatment. Fractional CO₂ laser combined with topical antifungal is a safe and effective treatment for onychomycosis.     

CO2激光治疗20种皮肤病疗效观察

目的：评价CO2激光治疗多种皮肤病的疗效及其在皮肤科治疗上的应用。方法：利用CO2激光的热作用对病变组织进行凝固、汽化和／或切割治疗，而使病变组织破坏而清除。结果：共治疗皮肤性病科20个病种1516例患者，治疗次数1～2次，痊愈1459例(96.24％)，显效54例(3．56％)，有效3例(0．20％)，无效0例(0．00%)。结论：CO2激光对皮肤科多种疾病有较好疗效。     

光学治疗在甲真菌病中的应用

甲真菌病是甲板和甲床被皮肤癣菌或其他真菌感染所引起的病变,常用的治疗方法包括局部外用或口服抗真菌药物治疗及拔甲治疗,但这些方法均存在一定的缺陷.近年来,光学治疗被应用于甲真菌病的治疗中,目前用于甲真菌病的光学治疗包括光动力治疗和激光治疗,它们分别通过光化学反应及选择性光热作用原理治疗甲真菌病.多项临床研究均表明,光动力疗法和激光可以有效治疗甲真菌病,且不良反应小.概述光学治疗甲真菌病的机制,疗效及安全性.     

长脉宽Nd:YAG激光治疗甲真菌病疗效观察

目的 探讨长脉宽Nd:YAG激光治疗甲真菌病的疗效及安全性。 方法 对35例甲真菌病患者使用长脉宽Nd:YAG激光进行治疗,治疗参数：波长1064 nm,能量30 ～ 40 J/cm2,脉宽35 ms,光斑4 mm。观察疗效及不良反应,并根据不同感染菌种、临床类型、病甲位置对病例进行分组,采用SPSS17.0统计软件进行卡方检验比较不同分组间疗效、复发情况的差异。结果 共治疗79甲,随访至初次治疗后9个月,临床有效率为67.1%,真菌学有效率为73.4%,复发或再感染率为19.0%。红色毛癣菌组的临床疗效（χ2 = 10.913,P < 0.05）及真菌学疗效（χ2 = 13.532,P < 0.05）均优于其他真菌组,复发或再感染率低于其他真菌组（χ2 = 10.980,P < 0.05）,但与白念珠菌组比较这三方面的差异均无统计学意义。白色浅表甲真菌病（WSO）组的临床疗效优于远侧甲下真菌病（DLSO）组（χ2 = 11.935,P < 0.05）,而DLSO组的临床疗效又优于近端甲下真菌病（PSO）及全甲营养不良甲真菌病（TDO）组（χ2 = 17.515,P < 0.05）。根据病甲位置不同分类,第2 ～ 5指甲组的临床疗效优于拇指甲/第2 ～ 5趾甲组（χ2 = 13.437,P < 0.05）及拇趾甲组（χ2 = 10.595,P < 0.05）,而拇指甲/第2 ～ 5趾甲组与拇趾甲组相比临床疗效差异无统计学意义（χ2 = 3.030,P > 0.05）,它们的真菌学疗效及治疗后的复发或再感染率差异无统计学意义。治疗过程中除疼痛外未发生其他不良反应。结论 长脉宽Nd:YAG激光是治疗甲真菌病的一种安全有效的方法,其疗效受到感染菌种、临床类型、病甲位置的影响。     

Phaeohyphomycosis of the ungual apparatus - Case report

Phaeohyphomycosis is a disease caused by dematiaceous fungi with a worldwidegeographic distribution and broad spectrum. It is most commonly found in adultindividuals of both genders and all races. We report the case of a 57-year-oldwoman with phaeohyphomycosis in the ungual apparatus.     

Darier–White disease treated with fractional CO2 laser in two cases

Darier–White disease is one of the most common genodermatoses. The most typical clinical symptoms such as diffuse hyperkeratotic papulae usually appear during puberty or early adulthood in seborrhoeic area. It is connected with substantial deterioration of the quality of life due to aesthetic defect. Although there exist many therapeutic options, the disease still causes considerable therapeutic difficulties. Treatment with fractional CO₂ laser seems to be a promising therapeutic method. In this paper, we present two cases of patients with Darier's disease who have been treated with a fractional CO₂ laser with very good clinical outcome.     

Intensified photodynamic therapy of actinic keratoses with fractional CO2 laser: a randomized clinical trial

Background Photodynamic therapy (PDT) with methyl aminolaevulinate (MAL) is effective for thin actinic keratoses (AKs) in field‐cancerized skin. Ablative fractional laser resurfacing (AFXL) creates vertical channels that facilitate MAL uptake and may improve PDT efficacy. Objectives To evaluate efficacy and safety of AFXL‐assisted PDT (AFXL‐PDT) compared with conventional PDT in field‐directed treatment of AK. Methods Fifteen patients with a total of 212 AKs (severity grade I–III) in field‐cancerized skin of the face and scalp were randomized to one treatment with PDT and one treatment with AFXL‐PDT in two symmetrical areas. Following curettage of both treatment areas, AFXL was applied to one area using 10 mJ per pulse, 0·12 mm spot, 5% density, single pulse (UltraPulse^®, DeepFx handpiece; Lumenis Inc., Santa Clara, CA, U.S.A.). MAL cream was then applied under occlusion for 3 h and illuminated with red light‐emitting diode light at 37 J cm^?2. Fluorescence photography quantified protoporphyrin IX (PpIX) before and after illumination. Results At 3‐month follow‐up, AFXL‐PDT was significantly more effective than PDT for all AK grades. Complete lesion response of grade II–III AK was 88% after AFXL‐PDT compared with 59% after PDT (P = 0·02). In grade I AK, 100% of lesions cleared after AFXL‐PDT compared with 80% after PDT (P = 0·04). AFXL‐PDT‐treated skin responded with significantly fewer new AK lesions (AFXL‐PDT n = 3, PDT n = 11; P = 0·04) and more improved photoageing (moderate vs. minor improvement, P = 0·007) than PDT‐treated skin. Pain scores during illumination (6·5 vs. 5·4; P = 0·02), erythema and crusting were more intense, and long‐term pigmentary changes more frequent from AFXL‐PDT than PDT (P = not significant). PpIX fluorescence was higher in AFXL‐pretreated skin [7528 vs. 12 816 arbitrary units (AU); P = 0·003] and photobleached to equal intensities after illumination (AFXL‐PDT 595 AU, PDT 454 AU; P = 0·59). Conclusions AFXL‐PDT is more effective than conventional PDT for treatment of AK in field‐cancerized skin.     

特比萘芬短程疗法治疗手指甲癣

用特比萘芬（Ｔｅｒｂｉｎａｆｉｎｅ）治疗手指甲癣病人２０例，剂量为２５０ｍｇ，每天１次，１周后隔日１次，共５周，总量为５２５０ｍｇ。４月后判断疗效。结果痊愈１８例，好转２例，有效率为１００％，痊愈率为９０％。服药期间未发现有明显副作用。证明特比萘芬短程疗法治疗手指甲癣是一个疗效高、安全可靠、简单易行的好方法。     

Unusual manifestation of the yellow nail syndrome - Case report

The yellow nail syndrome is a rare disorder characterized by the classic triad of yellow and dystrophic nails, lymphedema and pleural effusion. We report in this paper a case of yellow nail syndrome, presenting the classic triad of the disease, associated with an unusual lymph accumulation in the abdomen region.     

CO2点阵激光联合308 nm准分子激光治疗白癜风疗效和安全性meta分析

目的：评价CO₂点阵激光联合308 nm准分子激光治疗白癜风的临床疗效和安全性。方法：通过检索Cochrane Library、PubMed、Embase、万方、中国知网、维普数据库,收集CO₂点阵激光与308 nm准分子激光联合治疗白癜风相关的文献,运用软件（Revman 5.3）进行Meta分析。结果：13篇临床随机对照实验被纳入,其中1014处皮损给予CO₂点阵激光与308 nm准分子激光联合治疗,1005处皮损给予308 nm准分子激光单独治疗。结果显示：联合疗法总有效率和显效率优于单用308 nm准分子激光;两组不良反应发生率无明显差异。结论： CO₂点阵激光+308 nm准分子激光联合治疗白癜风的疗效优于单独使用308 nm准分子激光,且两种疗法的不良反应没有明显差异。