Onychomycosis is a fungal infection of the nail. Onychomycosis can cause discomfort, pain, and disfigurement leading to serious physical and occupational limitations. Onychomycosis is a deep-seated, recalcitrant condition with a 40% to 70% recurrence rate, which includes either relapse or reinfection. Oral antifungals are the standard of care because topical application has limited effectiveness due to the difficulty of nail penetration. However, systemic antifungals are associated with hepatic toxicity and drug interactions. Additionally, topical or oral antifungal treatment must be maintained for several months for maximal effectiveness, and patient compliance is a common issue.

Description of Technology: Neodymium-doped yttrium aluminium garnet (Nd:YAG) lasers typically have a wavelength of 1064 nanometers and a variety of pulse durations to impact the power of laser treatment, including long-pulsed (milliseconds), short-pulsed (microseconds), and Q-switched (nanoseconds).

Patient Population: Laser therapy is indicated for patients with toenail or fingernail onychomycosis.

Clinical Alternatives: Onychomycosis may be treated with oral (e.g., terbinafine, itraconazole, fluconazole, posaconazole, griseofulvin) or topical (e.g., ciclopirox olamine, efinaconazole, amorolfine, bifonazole, tioconazole, tavaborate) antifungal agents or nonpharmacologic treatments (e.g., laser treatment, photodynamic therapy, nail debridement, nail evulsion). Pharmacologic and nonpharmacologic treatments may also be used in combination.

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