Efficiency of methylene blue-mediated photodynamic therapy vs intense pulsed light in the treatment of onychomycosis in the toenails

Photodermatol Photoimmunol Photomed. 2019 Mar;35(2):69-77. doi: 10.1111/phpp.12420. Epub 2018 Sep 17.


Background: Photodynamic therapy (PDT) or intense pulsed light (IPL) are efficient therapeutic methods in the treatment of superficial skin infections, and thus, they could be good options for onychomycosis treatment, the most common nail disorder.

Methods: Forty patients, affected with different diagnosed types of onychomycosis in nails of the first toe, were randomly divided into two groups of 20 patients to be treated by PDT or IPL. Nail plates were softened with urea 40% by occlusive dressing for 12 hours during 3-7 days before treatments. Then, eight sessions separated by an interval of 2 weeks of a PDT protocol mediated by methylene blue (MB) and red laser diode (Periowave® , λ = 670 nm, 200 mW) or an IPL protocol based on 10 pulses/cm2 (Dye-VL-F module, Alma Lasers, λ = 500-600 nm, 10 J) were applied.

Results: Both treatments reduced significantly the Onychomycosis Severity Index (OSI) (P < 0.05). In terms of complete cure: 70% (PDT) and 80% (IPL) of the patients reached it after 12 weeks post-treatment. No patient reported any adverse effects or complications, although in the IPL Group, some referred pain sensation during light irradiation and hematomas apparition.

Conclusions: Photodynamic therapy and IPL were effective for onychomycosis cure of any etiology.

Keywords: intense pulsed light; methylene blue; onychomycosis; photodynamic therapy.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Female
  • Humans
  • Male
  • Methylene Blue / administration & dosage*
  • Middle Aged
  • Nails / metabolism
  • Nails / microbiology
  • Nails / pathology
  • Onychomycosis / drug therapy*
  • Onychomycosis / metabolism
  • Onychomycosis / pathology
  • Photochemotherapy*


  • Methylene Blue