Onychomycosis is a common chronic-resistant
nail disease. Traditional treatment has its limitations and side effects. This study aimed to evaluate the role of fractional
CO2 laser and topical
tioconazole 28% nail lacquer in the treatment of fingernail
onychomycosis, as sole treatment modalities and in combination. Thirty patients with culture-proven
onychomycosis were included and randomly divided into three equal groups.
Laser group received six fractional
carbon dioxide (
CO2) laser sessions at monthly intervals; topical group received topical
tioconazole 28% nail lacquer twice daily for 6 months, and combined group received six fractional
CO2 laser sessions at monthly intervals with topical
tioconazole twice daily for 6 months. Treatment outcome was evaluated through physician's evaluation of improvement using
onychomycosis severity index score (OSI), patients' satisfaction, side effect evaluation, and mycological culture (assessed after the end of treatment). At the end of treatment, both
laser and combined groups showed significantly better degrees of improvement (P = 0.036, 0.024, respectively) and patient's satisfaction (P = 0.046, 0.003, respectively) in comparison with topical group. Mycological clearance in fungal cultures was significantly higher in combined group than topical group after the end of treatment (P = 0.007). Fractional
CO2 laser is a safe and effective treatment modality for
onychomycosis. Its efficacy approximates that of fractional
CO2 laser combined with topical
tioconazole 28% nail lacquer and surpasses that of topical
tioconazole 28% monotherapy. It is expected to be an excellent choice for patients in whom systemic antifungals are contraindicated or who are unresponsive or intolerant to topical antifungals.