A Study of Q-switched Nd:YAG Laser versus Itraconazole in Management of Onychomycosis

CONTEXT: Onychomycosis (OM) accounts for 20%–40% of all nail disorders. Slow growth of nails, resistance to antifungal drugs, their side effects, and drug interactions limit treatment options. Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser is approved for nail clearance of OM, however conflicting reports exist in literature about its efficacy. This study was conducted to compare the efficacy of Q-switched Nd:YAG laser. AIM: The aim of this study was to find the efficacy of Q-switched Nd:YAG laser (1064 nm) management of OM as monotherapy in comparison to itraconazole. SETTINGS AND DESIGN: A randomized parallel group, outcome assessor trial was conducted over 18 months from July 1, 2015 to December 31, 2016, at skin center of a tertiary care hospital. SUBJECTS AND METHODS: In the first group, patients of OM were administered 12 weekly sessions of the laser. Second group was administered itraconazole 200 mg twice a day for 1 week per month for the 3 months. Confirmed cases of OM, who had not received treatment 6 months before presentation, were selected and randomly allocated to two groups of 50 each. Onychomycosis severity index (OSI) and visual analog scale (VAS) score were used to assess nail involvement at the start of study, 3 months and 1 year after enrollment. STATISTICAL ANALYSIS: Clinical profile of patients was analyzed by chi-square test for qualitative variables. For comparison of quantitative variables, Student t test was performed. A 5% probability level was considered as statistically significant (P < 0.05). RESULTS: VAS and OSI showed statistically significant improvement at 3 and 12 months in Group I, while resulting in faster clearance with laser; OSI was comparable in both groups at 12 months. Mycological cure was significantly higher in Group I. Both dermatophytes as well as non-dermatophytes responded well to laser treatment, whereas non-dermatophytes responded better to laser. CONCLUSIONS: Q-switched Nd:YAG laser is effective in inducing nail clearance in OM and is better than itraconazole in managing non-dermatophyte OM.