Q-switched Nd-Yag 1064 nm Laser Theraphy for Onychomycosis: Two Case Reports
Keywords:candida, laser treatment, non dermatophyte, onychomycosis, qswitch-ndyag
AbstractIntroduction: Onychomycosis is the most common nail disease. Current treatment strategies include the use of oral and topical antifungals. Laser is one of the therapeutic options that can be used. Case reports: We report 2 cases of onychomycosis with distolateral subungual and proximal subungual types, in which nail discoloration and subungual hyperkeratosis were found. Onychoscopy examination revealed longitudinal lines and jagged spikes. Potassium hydroxide examination was positive in both cases, with spores found in the first case and long hyphae in the second case. Culture examination from nail scrapings showed identification of Candida tropicalis, and PCR sequencing examination in the second patient showed identification of Aspergillus persii. Based on the history, physical examination, and investigations, the diagnosis of non-dermatophyte onychomycosis was established. Treatment with Q-switched Nd-Yag 1064 laser, with spot sizes of 3mm, 4Hz, and 1000 mJ/P, and a 2-week treatment interval were given to the patient with 3 dan 4 sessions, respectively. Discussion: Q-switched Nd-YAG laser are by photothermolysis, targeting xanthomagnin and melanin so that it has a fungicidal effect Clinical response was observed to improve after 3 and 4 times of therapy with Q-switched Nd-Yag 1064 laser, with spot sizes of 3mm, 4Hz, and 1000 mJ/P, and a 2-week treatment interval. Conclusion: Laser therapy modalities still have a low cure rate as a single therapy for onychomycosis. Combination oral therapy and laser therapy should be suggested to accelerate healing and provide maximum results.
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