Onychomycosis Essay
INTRODUCTION Onychomycosis is defined as a fungal infection of the nail that expands slowly and if left untreated leads to complete destruction of the nail plate,it can be dermatophytic (99%) and/or nondermatophytic (1%) (Including yeasts) infections of the nail plate. (1) The dermatophytes Trichophyton rubrum and Trichophyton mentagrophytes are the most common causative pathogens responsible for up to 90% of all cases.(1) Onychomycosis represents about 30% of all dermatophyte infections and accounts for 18%–40% of all nail disorders.(2) The prevalence of onychomycosis ranges between 2% and 28% of the general population and it is estimated to be significantly higher in specific populations such as in diabetes mellitus,
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Also, it may predispose patients to secondary bacterial infections leading to localized paronychia and perhaps worse and deeper infections such as erysipelas-cellulitis, especially in the high-risk groups such as diabetics.(6-7) Clinically it can cause varying degrees of pain or discomfort (especially in walking) and problems in cutting nails.(8) The efficacy of current treatment options, including topical, oral, mechanical and chemical therapies or a combination of these modalities is low. (9)
Topical drug treatment for onychomycosis is not usually successful because they are unable to penetrate the nail plate (10) and rapid recurrence can occur after discontinuing use.(11)
Oral antifungal agents are more effective although more toxic with a significant risk of liver toxicity, prolonged loss of taste, and life threatening drug interactions. Fungal resistance can occur when the oral antifungal agents are used on a long-term basis. …show more content…
Yet, this often ineffective and traumatic procedure leaves the subject without a nail for months at risk for reinfection. (13)
Given the limitations of current treatment options, there is a great need for a simple, nontoxic and effective alternative treatment. (14)
Laser device systems are the most rapidly expanding area of onychomycosis therapy. Laser device systems target the invasive fungal infection in the nail apparatus using selective photothermolysis, which relies on selective absorption of a brief radiation pulse to create and confine heat energy in fungi .(15-16)
The Nd:YAG laser is such a device, with a wavelength (1064 nm) that will pass through the nail plate and into the nail bed, resulting in superheating of the fungal material. Exposure of fungi to high temperatures inhibits their growth as well as causing cell damage and death. (17-18)
Q-switched laser systems: The Q-Switched Nd:YAG laser is the only Q-switched system approved for the treatment of onychomycosis .Q-switched lasers have a pulse duration in the nanosecond range and they have the highest maximum pulse energy of the commercial solid state lasers.
Also, it may predispose patients to secondary bacterial infections leading to localized paronychia and perhaps worse and deeper infections such as erysipelas-cellulitis, especially in the high-risk groups such as diabetics.(6-7) Clinically it can cause varying degrees of pain or discomfort (especially in walking) and problems in cutting nails.(8) The efficacy of current treatment options, including topical, oral, mechanical and chemical therapies or a combination of these modalities is low. (9)
Topical drug treatment for onychomycosis is not usually successful because they are unable to penetrate the nail plate (10) and rapid recurrence can occur after discontinuing use.(11)
Oral antifungal agents are more effective although more toxic with a significant risk of liver toxicity, prolonged loss of taste, and life threatening drug interactions. Fungal resistance can occur when the oral antifungal agents are used on a long-term basis. …show more content…
Yet, this often ineffective and traumatic procedure leaves the subject without a nail for months at risk for reinfection. (13)
Given the limitations of current treatment options, there is a great need for a simple, nontoxic and effective alternative treatment. (14)
Laser device systems are the most rapidly expanding area of onychomycosis therapy. Laser device systems target the invasive fungal infection in the nail apparatus using selective photothermolysis, which relies on selective absorption of a brief radiation pulse to create and confine heat energy in fungi .(15-16)
The Nd:YAG laser is such a device, with a wavelength (1064 nm) that will pass through the nail plate and into the nail bed, resulting in superheating of the fungal material. Exposure of fungi to high temperatures inhibits their growth as well as causing cell damage and death. (17-18)
Q-switched laser systems: The Q-Switched Nd:YAG laser is the only Q-switched system approved for the treatment of onychomycosis .Q-switched lasers have a pulse duration in the nanosecond range and they have the highest maximum pulse energy of the commercial solid state lasers.