Single-Session Fractional CO2 Laser following Urea Occlusion in Management of Onychomycosis: A Pilot Study

Abstract

Introduction: Onychomycosis is a common nail disorders. Antifungal resistance, interactions, and side effects limit treatment options. Fractional CO₂ (FCO₂) laser along with topical antifungal is effective in multiple monthly sessions. A modification reducing repeated visits and hence better compliance is preferable. Single-session FCO₂ laser following urea occlusion is reported to be effective. Thus, we conducted a study to determine the efficacy of single-session FCO₂ laser with 1% terbinafine cream with and without "urea cream occlusion" in managing onychomycosis.

Methods: A prospective, randomized, parallel-group study was conducted at a tertiary centre. Onychomycosis was confirmed by positive fungal mount and culture. Patients were randomized into 2 groups and administered single-session FCO₂ laser. Group A was treated after overnight urea cream occlusion and group B without occlusion. Both groups applied 1% terbinafine cream twice daily for 3 months. Response was assessed by improvement in Onychomycosis Severity Index (OSI) at 6 months.

Results: Group A had 10 patients, 14 nails. Clinical improvement was seen in 12/14 (85.7%) nails. Average reduction in OSI was 10.78. Group B had 10 patients, 11 nails. Clinical improvement was seen in 5/11 (45.5%) nails. Average reduction in OSI was 1.73. "Reduction in OSI" was statistically significant (p < 0.05) only in group A.

Conclusion: Single-session FCO₂ laser following overnight urea cream occlusion, followed by 1% terbinafine cream, is effective for management of onychomycosis.

Keywords: Fractional CO2 laser; Onychomycosis; Terbinafine; Urea cream.