الفهرس 
OnychomycosisOnly 14 pages are availabe for public view
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Abstract
Onychomycosis is a chronic fungal infection of the nail and may involve the nail bed, the nail plate, and the matrix. It is difficult to be treated. Relapses and reinfections are common. The diagnosis can be made only when both positive laboratory and clinical criteria are present. Onychomycosis can be caused by dermatophytes or non dermatophyte moulds. Onychomycosis can also be caused by more than 1 organism, for example, a non dermatophyte mould in addition to a dermatophyte. Clinical signs of onychomycosis include nail discoloration, hyperkeratosis, and onycholysis Onychomycosis frequently presents as distal-lateral subungual onychomycosis (DLSO), with fungi entering the nail through the distal and/or lateral sides of the nail plate.
The classical treatment modalities for onychomycosis include oral as well as topical antifungal, however, the cure rate is considered to be low and regression rate is found to be high. Topical antifungals are often ineffective because of their inability to penetrate via nail plate. Systemic treatments, although effective, have limited application because of adverse effects such as hepatotoxicity, potential drug interactions and congestive heart failure.
The mechanism by which fractional CO2 laser treats onychomycosis is mainly through vaporization and decomposition of target’s local tissue and its bactericidal effect. Fungi are extremely sensitive to temperature above 55 °C; the photothermal effect of fractional CO2 laser can increase the temperature of local tissue, thus it plays a direct role in killing the fungi in the laser-treated affected nail. Additionally, fractional CO2 laser makes the local tissue of affected nail vaporize and exfoliate, causing diffuse remodeling and at the same time destroys the fungal growth environment, thus contributing in fungal growth inhibition. Furthermore, fractional CO2 laser can enhance the absorption of topical antifungal agents, thereby improving its efficacy.
Our study aimed to evaluate the clinical efficacy of fractional carbon dioxide laser combined with topical antifungal in treatment of onychomycosis.
Our patients were subjected to Full history taking, family history, previous treatment methods used and history of other diseases, general examination, dermatological examination, local examination of the nail and calculation of Score Clinical Index of Onychomycosis.
Mycological examination (KOH 20 % and fungal culture) was done at the beginning of the study to confirm the diagnosis and at 3 months to evaluate treatment as regards mycological cure. The affected nails received 3 sessions of laser therapy (Fractional CO2 laser) at 4 weeks intervals and once daily application of topical antifungal. Evaluation of treatment response was done through Photography, Score clinical index of onychomycosis patient’s satisfaction as well as fungal culture at at the end of laser sessions to evaluate mycological cure.
Our results showed a highly significant difference between SCIO at baseline and both at the end of laser sessions and after 3 months of treatment with no significant correlation between clearance of organism after treatment and each of change and percent of change in SCIO at 6 months from baseline.
In conclusion Fractional carbon-dioxide laser therapy, combined with a topical antifungal agent, was effective in the treatment of onychomycosis. Studies demonstrating efficacy and comparing efficacy with oral antifungal agents are needed.