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Combination of Q-switched 1,064 and 532 nm Nd: YAG laser in the treatment of toenail onychomycosis: a pilot study

Summary

This study tested a laser treatment using two different wavelengths (1,064 and 532 nanometers) to treat toenail fungal infections. Fifteen patients with toenail fungus received eight weekly laser sessions. The treatment was safe and worked best for mild cases, curing 100% of them, but was less effective for severe infections. Although patients experienced some pain during treatment, the overall results suggest laser therapy could be a useful option for treating mild fungal toenail infections without the side effects of oral medications.

Background

Onychomycosis is a chronic fungal infection affecting approximately 30% of cutaneous fungal infections and 90% of toenail infections worldwide. Conventional antifungal treatments have limitations due to side effects and reduced efficacy. Q-switched Nd:YAG lasers have emerged as a promising non-pharmacological alternative for treating onychomycosis.

Objective

To assess the effectiveness of dual-wavelength (1,064 nm and 532 nm) Q-switched Nd:YAG laser as monotherapy for treating toenail onychomycosis caused by dermatophytes.

Results

At week 43, mycological cure rate and complete cure rate were both 33.3% (5 of 15 patients). Cure rates were 100% for mild cases, 40% for moderate cases, and 22.2% for severe cases. No adverse effects were reported, though pain scores averaged 6.5±0.5 for 1,064 nm and 7.8±0.5 for 532 nm applications.

Conclusion

The dual-wavelength Q-switched Nd:YAG laser is a safe and promising treatment for mild onychomycosis but shows limited effectiveness in severe cases. Further optimization of laser parameters, session frequency, and treatment protocols is needed to improve therapeutic outcomes.
  • Published in:Lasers in Medical Science,
  • Study Type:Pilot Clinical Trial,
  • Source: PMID: 41136799, DOI: 10.1007/s10103-025-04712-4
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