Diode Laser and Red-Laser Photodynamic Therapy with Toluidine Blue Gel for the Treatment of Onychomycosis: A Case Series

Abstract

Background: Onychomycosis is the most prevalent nail disease, posing a challenge for health professionals in terms of treatment. Conventional topical antifungal treatments can often prove insufficient, and the use of oral antifungal drugs carries a high frequency of adverse events and drug–drug interactions. Objective: The primary aim of this study was to determine the cure rate of onychomycosis using a combined treatment of diode laser and photodynamic therapy with red-laser photodynamic therapy (PDT) and toluidine blue gel. Methods: A series of onychomycosis cases were treated and monitored for 6 months with eight applications of diode laser therapy. This treatment was combined with three applications of red-laser PDT paired with toluidine blue gel. Clinical cure was evaluated one week after the treatment’s conclusion, while mycological cure was assessed via microbiological culture. Results: The study included 12 patients and a total of 17 nails. At the end of treatment, clinical, mycological, and complete cure rates were 100% for all patients and nails. No adverse reactions were reported during or after the PDT application. However, all patients experienced pain during laser application, and two patients experienced hematoma and subungual blistering post-treatment. Two patients (2/12) experienced recurrence in three nails (3/17; recurrence rate: 17.6%) within 6 months following treatment. Conclusions: The combination of diode laser therapy and red-laser PDT with toluidine blue gel seems effective and safe for the treatment of mild, moderate, and severe onychomycosis.