1,064-nm Diode Laser Therapy of Onychomycosis: Results of a Prospective Open Treatment of 82 Toenails
Bibliographic record
Abstract
BACKGROUND: Onychomycosis is one of the most prevalent nail disorders in adults, where conventional topical therapy is often protracted and in most cases ineffective. On the other hand, systemic/oral therapy is not suitable for all patients and might be associated with relevant side effects. Therefore, laser therapy can be used as an alternative to or extension of existing treatment protocols. OBJECTIVES: We used diode laser treatment for onychomycosis to evaluate the efficacy of this treatment as single therapy as well as in combination with an ongoing antimycotic treatment. METHODS: We used a 1,064-nm diode laser (FOX Laser, ARC Laser GmbH, Germany) in pulse mode with a spot size of 4 mm. The laser's settings were: 8 W, with a pulse duration of 80 ms and a repetition rate of 5.6 Hz; the energy fluence/pulse was 5.1 J/cm(2), and a total energy of 250-500 J for large and/or thickened nails (digit I), 120-200 J for medium nails (digits II-IV) and 60-120 J for small and/or very thin nail plates (digit V) was counted in the laser display. Two to three passes where applied continuously over the entire area of the nail (nail plate, nail folds and eponychium) in a grid pattern. Eighty-two affected toenails were treated at least twice every 8 weeks; all nails treated were clinically diagnosed as onychomycosis. The evaluation of the treated nails was conducted by two dermatologists, initially by semiquantitative visual examination, followed by evaluation with the Onychomycosis Severity Index (OSI). In addition, the patients were asked to state their satisfaction with the treatment and its results in a written questionnaire. RESULTS: All nails showed an improvement ranging between 14 and 56% including the analytical evaluation scale (OSI). Two dermatologists evaluated 34 nails. Both reported significant improvement and/or good clinical improvement, which corresponds to about 41% for both evaluations. The mean OSI of all patients was 18.9/19.9 before treatment which changed to 14.3/14.8 after treatment. This corresponds to an improvement of about 25% (-4.6/-5.1) compared to the initial value. Specifically the subgroup with positive antimycotic culture and no additional antimycotic treatment showed an improvement of about 25%. This improvement can be attributed to the effect of the diode laser treatment. When evaluating the OSI of all nails, it appears that about 15-20% of the severe OSIs improved and changed to a moderate level, while a similar portion of patients with moderate onychomycosis improved to mild onychomycosis. Patient satisfaction was measured to an average value of 4.6 out of a maximum of 10 points. About 60% of the treated patients would recommend the treatment to their family members or friends. CONCLUSION: This investigation demonstrated that diode laser treatment of onychomycosis provides acceptable results with minimal to no side effects. Further clinical evaluations could help to establish better therapy protocols, especially for those patients who had no benefit from the laser treatment, or could also be used as an add-on to an existing therapy.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".