Laser treatment of onychomycosis with a 1064 nm Nd:YAG laser - 5 nails, 1 session

Laser treatment of onychomycosis with Nd laser (1064 nm) - a method for treating fungal nail infection (onychomycosis), performed using the Again PRO Plus laser system manufactured by DEKA with an Nd source at a wavelength of 1064 nm.

Onychomycosis is a fungal infection of the nail apparatus affecting the toenails or fingernails. The most common causative agents are dermatophytes; less frequently, the condition is caused by yeasts and non-dermatophyte moulds. The infection may be accompanied by changes in nail color, thickening and crumbling of the nail plate, subungual hyperkeratosis, partial separation of the nail from the nail bed, discomfort or pain.

The method is based on controlled thermal exposure of laser energy to the nail plate and the underlying structures. The aim of the procedure is to affect fungal elements and create conditions for the gradual regrowth of a clinically healthy nail plate.

Non-ablative Nd 1064 nm exposure may be considered as an additional component of local or systemic antifungal therapy.

Laser treatment does not replace mycological diagnosis and does not guarantee complete elimination of the causative agent.

Indications

Nd 1064 nm laser treatment may be considered in cases of:

• clinically and mycologically confirmed onychomycosis of the toenails or fingernails;
• the need for an additional method as part of complex antifungal therapy;
• insufficient clinical response to previous treatment — after reassessment of the diagnosis and treatment strategy;
• contraindications or limitations to systemic therapy, when the laser procedure can be combined with appropriate topical treatment;
• the need to reduce the volume of affected nail material and support the growth of a healthy nail plate.

Procedure / duration

The procedure is performed by a qualified specialist trained to operate the Again PRO medical laser system.

The patient and specialist wear protective eyewear appropriate for the Nd 1064 nm wavelength.

Laser exposure is applied sequentially across the entire surface of the nail plate and the protocol-defined proximal area beyond the cuticle margin. The laser beam is moved gradually using a spiral or cross-pattern trajectory.

During treatment, the surface temperature of the nail plate is controlled:

• target range — 38–42 °C;
• the temperature must not exceed 42 °C.

During the procedure, the patient may experience gradually increasing warmth, tingling, or short-term discomfort. Temperature, patient sensations, and the response of the nail and periungual tissues are monitored throughout the treatment. If excessive pain, rapid temperature increase, or an undesirable tissue reaction occurs, the procedure is stopped immediately.

The interval between sessions is usually about 4 weeks. The number of procedures is determined individually, taking into account the severity of the condition, nail regrowth dynamics, and the composition of the combined treatment plan.

After the session, the patient can usually return to daily activities.

Contraindications

The procedure is not performed in cases of:

• peripheral neuropathy of the lower extremities, including diabetic neuropathy.

Reduced pain sensitivity increases the risk of unnoticed overheating, severe burns, necrosis, and infectious complications.

Limitations

The procedure is postponed until further assessment in cases of:

• subungual hematoma or an unidentified pigmented lesion;
• bacterial infection of the nail or surrounding tissues;
• active wounds, erosions, or skin damage;
• nail psoriasis, lichen planus, or another nail dystrophy that may mimic onychomycosis;
• the use of products or dyes that significantly alter the color of the nail plate;
• the presence of a tumor or pre-tumor lesion in the treatment area.

Pregnancy, breastfeeding, pronounced photosensitivity, light-induced seizure disorders, severe systemic diseases, impaired peripheral circulation, and the use of photosensitizing medications, anticoagulants, or immunosuppressants require prior individual assessment.

The patient should not discontinue prescribed medications independently. The possibility of temporary discontinuation is determined by the medical specialist who prescribed the respective therapy.

Medical sources:

https://www.efsm.online/int_en/article-overview/106/2023/onychomycosis-guideline-update
https://pubmed.ncbi.nlm.nih.gov/31978269/