关键词: 治疗, 临床研究性

Abstract:

Yang Yang*, Liu Han, Yang Rongya, Huang Xinxin, Jing Dongyun, Wang Ling, Liu Weida, Lyu Xuelian. *Department of Dermatology, General Hospital of Beijing Military Command, Beijing 100700, China Corresponding authors: Lyu Xuelian, Email: mycoses@gmail.com; Liu Weida, Email: liuweida@medmail.com.cn 【Abstract】 Objective To evaluate the efficacy and safety of a superpulse-mode fractional carbon dioxide （CO2） laser for the treatment of onychomycosis. Methods Patients with typical clinical manifestations of onychomycosis and positive for direct microscopic examinations of fungi were enrolled into this study, and treated with a superpulse-mode fractional CO2 laser for eight sessions. The scoring clinical index for onychomycosis （SCIO） and onychomycosis severity index （OSI） were calculated according to patients′ age, clinical type of onychomycosis, thickness of nails, area and length of nail involvement before the treatment, at the end of treatment, 1 month and 3 months after completion of treatment. Mycological clearance was also evaluated according to direct microscopy and fungal culture results. Adverse reactions to laser therapy were recorded. Statistical analysis was carried out by using the chi-square test and Wilcoxon signed-rank sum test with the SPSS 17.0 software. Results Totally, 20 patients with onychomycosis were enrolled into this study, and 75 affected nails were treated. Finally, 18 patients with 71 target nails completed the treatment and follow-up. The SCIO and OSI were 13.07 ± 6.47 and 21.11 ± 11.94 in these patients at baseline respectively, both significantly different from those at the end of treatment （9.03 ± 6.14 and 13.63 ± 12.10, respectively, both P < 0.05）, 1 month （（8.51 ± 6.99 and 14.18 ± 13.65, respectively, both P < 0.05） and 3 months （7.89 ± 7.26 and 13.70 ± 13.93 respectively, both P < 0.05） after completion of treatment. No significant differences were observed in mycological clearance rates between the posttreatment time points （57.75% （41/71） at the end of treatment vs. 59.15% （42/71） at 1 month vs. 61.97% （44/71） at 3 months after completion of treatment, P > 0.05）. The SCIO and OSI decreased from 12.48 ± 5.41 and 16.44 ± 9.89 at the baseline to 5.01 ± 5.56 and 6.44 ± 8.26 at 3 months after the treatment, respectively, in patients with distal and lateral subungual onychomycosis （DLSO）, and from 17.86 ± 3.98 and 34.05 ± 2.56 to 15.88 ± 4.10 and 31.00 ± 7.28 respectively in patients with total dystrophic onychomycosis （TDO）. During the treatment, several patients felt transient mild pain, but no subungual hemorrhage or other adverse reactions occurred. Conclusions The fractional CO2 laser in superpulse mode shows a reliable efficacy for the treatment of mild to moderate onychomycosis such as DLSO, especially when the nail plate is superficially invaded and grows rapidly. It directly inhibits and kills fungi, and treatment duration should be prolonged according to conditions.