Usefulness of Photodynamic Therapy in the Management of Onychomycosis

Actas Dermosifiliogr. 2015 Dec;106(10):795-805. doi: 10.1016/j.ad.2015.08.005. Epub 2015 Oct 1.
[Article in En, Spanish]

Abstract

Onychomycosis, or fungal infection of the nails, is one of the most prevalent fungal diseases in the general population. Treatment is of limited effectiveness, tedious, and must be administered for long periods. Furthermore, systemic antifungal agents are associated with adverse effects. Photodynamic therapy (PDT) may prove to be a viable alternative in the treatment of superficial skin infections, including onychomycosis. We review articles relating to the usefulness of PDT in onychomycosis in both in vitro and in vivo settings and discuss the potential and limitations of various photosensitizing agents. In vivo, methylene blue and 5-aminolevulinic acid have led to cure rates in 80% and 43% of cases, respectively, at 12 months. Finally, based on data in the literature and our own experience, we propose a protocol of 3 PDT sessions, separated by an interval of 1 or 2 weeks, using methyl aminolevulinate 16% as a photosensitizing agent and red light (λ=630 nm, 37 J.cm(-2)). Each session is preceded by the topical application of urea 40% over several days. Clinical trials are needed to optimize PDT protocols and to identify those patients who will benefit most from this treatment.

Keywords: 5-aminolevulinic acid; 5-methylaminolevulinic acid; Azul de metileno; Methylene blue; Onicomicosis; Onychomycosis; Photodynamic therapy; Terapia fotodinámica; Ácido 5-aminolevulínico; Ácido 5-metilaminolevulínico.

Publication types

  • Review

MeSH terms

  • Aminolevulinic Acid / administration & dosage
  • Aminolevulinic Acid / analogs & derivatives
  • Aminolevulinic Acid / therapeutic use
  • Antifungal Agents / therapeutic use
  • Clinical Protocols
  • Clinical Trials as Topic
  • Drug Administration Schedule
  • Evidence-Based Medicine
  • Fungi / drug effects
  • Fungi / radiation effects
  • Humans
  • Methylene Blue / administration & dosage
  • Methylene Blue / therapeutic use
  • Onychomycosis / drug therapy*
  • Photochemotherapy / methods*
  • Photosensitizing Agents / administration & dosage
  • Photosensitizing Agents / therapeutic use*
  • Treatment Outcome
  • Urea / administration & dosage
  • Urea / therapeutic use

Substances

  • Antifungal Agents
  • Photosensitizing Agents
  • methyl 5-aminolevulinate
  • Aminolevulinic Acid
  • Urea
  • Methylene Blue