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The Best of the Best
Aug 2011

Top-Accessed Article: Successful Treatment of Toenail Onychomycosis

Author Affiliations

Author Affiliations: Department of Dermatology, Case Western Reserve University, Cleveland, Ohio.

Arch Dermatol. 2011;147(8):966. doi:10.1001/archdermatol.2011.202

Watanabe D, Kawamura C, Masuda Y, Akita Y, Tamada Y, Matsumoto Y. Successful treatment of toenail onychomycosis with photodynamic therapy. Arch Dermatol. 2008;144(1):19-21.

This cutting-edge article by Watanabe and colleagues describes a promising treatment option for a chronic and recalcitrant type of infection. Although studies have shown that photodynamic therapy exerts antifungal activity, very little is known regarding its clinical efficacy. Onychomycosis is of particular significance because of the limitations of current treatments. The nail is such a formidable barrier that penetration of topically applied agents is seldom achieved. Therefore, physicians resort to the use of systemic antifungal agents, which, although effective, often involve adverse effects. The penetration of 5-aminolevulinic acid was facilitated by the preapplication of urea cream, 20%. Although pain was reported, the procedure was clearly noninvasive and relatively well tolerated. A weekly dosing schedule seemed reasonable. Because of the depth of the infection, activation of protoporphyrin IX was performed using the longer wavelength (630 nm). Based on the positive clinical results induced by photodynamic therapy with 5-aminolevulinic acid, which were accompanied by clearance of the fungi by potassium hydroxide preparation examination, this therapy should be considered for onychomycosis, especially in patients who are not good candidates for systemic antifungal agents.

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