Department of Community Medicine & School of Public Health, PG...

Background Onychomycosis accounts for 20-40 of all nail disorders It is difficult to cure with resistance to anti-fungal drugs their side effects and drug interactions limiting treatment options Itraconazole is a widely accepted oral medication used for onychomycosis while fractional CO2 laser along with a topical anti-fungal has shown promising results for nail plate clearance in onychomycosis Aim To compare the efficacy of fractional CO2 laser with 1 terbinafine cream versus itraconazole in the management of onychomycosis Methods A prospective randomised single-centre two-arm parallel-group interventional study was conducted at Command Hospital Air Force Bangalore Onychomycosis cases confirmed by KOH mount culture-positive were included Patients were randomly divided into two groups Group A received 4 sessions of fractional CO2 laser every fourth week with twice-daily application of 1 terbinafine cream Group B received one-week pulse therapy with capsule itraconazole once every four-week for three pulses The response was assessed by Onychomycosis Severity Index a validated onychomycosis assessment scale at baseline and at six months Results Group A had 50 patients with a total of 98 nails Clinical improvement was seen in 83 98 84 7 nails The average reduction in Onychomycosis Severity Index was 8 65 P 0 05 Group B had 50 patients with a total of 136 nails Clinical improvement was seen in 104 136 76 5 nails The average reduction in Onychomycosis Severity Index was 7 37 P 0 05 Both groups showed statistically significant improvement measured by Reduction in Onychomycosis Severity Index at six months however there was no significant difference between the two arms Limitations The main limitations of the study are the small sample size and lack of long-term follow-up to assess recurrence of infection Conclusion Fractional CO2 laser with 1 terbinafine cream is an effective and safe method for inducing nail clearance in onychomycosis and has efficacy similar to itraconazole pulse therapy

Department of Community Medicine & School of Public Health, PGIMER, Chandigarh, India.

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Fractional CO2 laser with topical 1% terbinafine cream versus oral itraconazole in the management of onychomycosis: A ra...