Lasertherapie der Onychomykose: Aktueller Stand

Zusammenfassung

Die Therapie des Nagelpilzes beschränkte sich bislang auf antimykotische Externa und die systemische Therapie. Die zunehmend durchgeführte Lasertherapie könnte die Behandlung der Onychomykose richtungsweisend verändern. Die verfügbaren Lasersysteme werden mit kurzen Behandlungszeiten, Nebenwirkungsfreiheit und hoher Effektivität beworben. Nach Zulassung der meisten Geräte durch die FDA (U.S. Food and Drug Administration) steht dem flächendeckenden Einsatz nichts mehr im Wege. Demgegenüber steht eine fehlende Evidenz durch klinische Studien von guter wissenschaftlicher Qualität.

Im Folgenden werden die verfügbaren Geräte samt publizierter Studien zusammenfassend vorgestellt und kritisch diskutiert.

Abstract

Antimycotic ointment and systemic therapy have been the state of the art treatment of nail fungus for years. Since laser therapy has recently been performed on a larger scale, it could give direction to onychomycosis treatment in the future. The available laser systems are advertised with considerable advantages: short time of treatment, no adverse effects, complete nail clearance after a few sessions. Most of the devices are FDA (U.S. Food and Drug Administration) approved but the lack of evidence and clinical trials that were published in influential journals tarnish the positive image.

In this overview available laser devices and published research studies are presented and discussed in a critical manner.

• Literatur

• 1 Ghannoum MA, Hajjeh RA, Scher R et al. A large-scale North American study of fungal isolates from nails: the frequency of onychomycosis, fungal distribution, and antifungal susceptibility patterns. J Am Acad Dermatol 2000; 43: 641-648
• 2 Schlefman BS. Onychomycosis: a compendium of facts and a clinical experience. J Foot Ankle Surg 1999; 38: 290-302
• 3 Drake LA, Patrick DL, Fleckman P et al. The impact of onychomycosis on quality of life: development of an international onychomycosis-specific questionnaire to measure patient quality of life. J Am Acad Dermatol 1999; 41: 189-196
• 4 Evans EG. Causative pathogens in onychomycosis and the possibility of treatment resistance: a review. J Am Acad Dermatol 1998; 38: 32-36
• 5 Zaias N, Glick B, Rebell G. Diagnosing and treating onychomycosis. J Fam Pract 1996; 42: 513-518
• 6 Gupta AK, Drummond-Main C, Cooper EA et al. Systematic review of nondermatophyte mold onychomycosis: Diagnosis, clinical types, epidemiology, and treatment. J Am Acad Dermatol 2012; 66: 494-502
• 7 Albert SF, Weis ZH. Management of onychomycosis with topicals. Clin Podiatr Med Surg 2004; 21: 605-615 vii
• 8 Bodman MA, Feder L, Nace AM. Topical treatments for onychomycosis: a historical perspective. J Am Podiatr Med Assoc 2003; 93: 136-141
• 9 Brenner MA, Harkless LB, Mendicino RW et al. Ciclopirox 8 % nail lacquer topical solution for the treatment of onychomycosis in patients with diabetes: a multicenter, open-label study. J Am Podiatr Med Assoc 2007; 97: 195-202
• 10 Tosti A, Piraccini BM, Stinchi C et al. Relapses of onychomycosis after successful treatment with systemic antifungals: a three-year follow-up. Dermatology 1998; 197: 162-166
• 11 Finch JJ, Warshaw EM. Toenail onychomycosis: current and future treatment options. Dermatol Ther 2007; 20: 31-46
• 12 De Doncker P, Decroix J, Pierard GE et al. Antifungal pulse therapy for onychomycosis. A pharmacokinetic and pharmacodynamic investigation of monthly cycles of 1-week pulse therapy with itraconazole. Arch Dermatol 1996; 132: 34-41
• 13 Piraccini BM, Sisti A, Tosti A. Long-term follow-up of toenail onychomycosis caused by dermatophytes after successful treatment with systemic antifungal agents. J Am Acad Dermatol 2010; 62: 411-414
• 14 Gupta AK, Uro M, Cooper EA. Onychomycosis therapy: past, present, future. J Drugs Dermatol 2010; 9: 1109-1113
• 15 Gupta A, Simpson F. Device-based therapies for onychomycosis treatment. Skin Therapy Lett 2012; 17: 4-9
• 16 Gupta AK, Simpson F. Newly approved laser systems for onychomycosis. J Am Podiatr Med Assoc 2012; 102: 428-430
• 17 Altshuler GB, Anderson RR, Manstein D et al. Extended theory of selective photothermolysis. Lasers Surg Med 2001; 29: 416-432
• 18 Emyanitoff RG, Hashimoto T. The effects of temperature, incubation atmosphere, and medium composition on arthrospore formation in the fungus Trichophyton mentagrophytes. Can J Microbiol 1979; 25: 362-366
• 19 Hashimoto T, Blumenthal HJ. Survival and resistance of Trichophyton mentagrophytes arthrospores. Appl Environ Microbiol 1978; 35: 274-277
• 20 Bornstein E, Hermans W, Gridley S et al. Near-infrared photoinactivation of bacteria and fungi at physiologic temperatures. Photochem Photobiol 2009; 85: 1364-1374
• 21 Raulin C, Kimmig W, Werner S. [Laser therapy in dermatology and esthetic medicine. Side effects, complications and treatment errors]. Hautarzt 2000; 51: 463-473
• 22 Manevitch Z, Lev D, Hochberg M et al. Direct antifungal effect of femtosecond laser on Trichophyton rubrum onychomycosis. Photochem Photobiol 2009; 86: 476-479
• 23 Landsman AS, Robbins AH. Treatment of Mild, Moderate, and Severe Onychomycosis Using 870- and 930-nm Light Exposure: Some Follow-up Observations at 270 Days. J Am Podiatr Med Assoc 2012; 102: 169-171
• 24 Landsman AS, Robbins AH, Angelini PF et al. Treatment of mild, moderate, and severe onychomycosis using 870- and 930-nm light exposure. J Am Podiatr Med Assoc 2010; 100: 166-177
• 25 Hochman LG. Laser treatment of onychomycosis using a novel 0.65-millisecond pulsed Nd:YAG 1064-nm laser. J Cosmet Laser Ther 2011; 13: 2-5
• 26 Kozarev J, Vizintin Z. Novel laser therapy in treatment of onychomycosis. Journal of the Laser and Health Academy 2010; 1-8
• 27 Zhang RN, Wang DK, Zhuo FL et al. Long-pulse Nd:YAG 1064-nm laser treatment for onychomycosis. Chin Med J (Engl) 2012; 125: 3288-3291
• 28 Weiss D. 3 month clinical results using sub-millisecond 1064 nm Nd:YAG laser for the treatment of oynchomycosis. Available at: http://conejofeet.com/wp-content/uploads/2011/06/David-Weiss-DPM-report.pdf Dem Internet entnommen im August 2012.
• 29 Kimura U, Takeuchi K, Kinoshita A et al. Treating Onychomycoses of the Toenail: Clinical Efficacy of the Sub-Millisecond 1,064 nm Nd:YAG Laser Using a 5 mm Spot Diameter. J Drugs Dermatol 2012; 11: 496-504
• 30 VwG Arnsberg. Beschl. vom 8. 5. 2012. 3L247/12.