الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Onychomycosis is a persistent fungal infection of the nail bed and plate and is most commonly (85–90%) caused by dermatophytes such as Trichophyton rubrum.
The treatment of onychomycosis is challenging because the infection is embedded within the nail. Light-based technologies, including PDT and laser, are promising modalities for the treatment of onychomycosis and an alternative for patients who suffer from chronic illness.
We aimed to conduct a clinical trial to assess and compare the efficacy of a PDT mediated by methylene blue and intense pulsed light versus the use of fractional CO2 laser in onychomycosis treatment.
This study was a prospective comparative study conducted on 51 patients with all types of onychomycoses who were recruited from the Dermatology Outpatient Clinic of the Alexandria Main University Hospital.
The patients were divided into three groups, each group included 17 patients with onychomycosis. In group A, patients were treated using PDT using methylene blue and IPL, while in group B patients were treated using was treated using fractional CO2 laser, and in group C patients were treated using combined fractional CO2 laser and photodynamic therapy.
In the current study, the age of patients ranged from 19 to 65 years, females were more predominant than males and the majority of them were housewives mostly from urban areas.
Cultures from three groups showed that candida was the most common isolated organism, representing 64.7% (11 patients) in the PDT group, 70.6% (12 patients) in the FCO2 group, and 70.6% (12 patients) in the combined group.
The most frequent dermoscopic finding in the TDO type was subungual hyperkeratosis in 6 patients (100%). The most frequent dermoscopic findings in the DLSO type were longitudinal streaks and striae in 33 patients (75%), jagged proximal edge in 31 patients, and pigmentation in 30 patients (68.2%). Irregular matt patches were shown in only one patient (100%) of PSO type.
We found that PDT, FCO2, and FCO2-assisted PDT were all efficient in improving the PND%. PND% showed statistically significant improvement after treatment and 6 months after treatment in the PDT, FCO2, and combined groups. Although no statistical significance was reported between the three treatment methods, FCO2-assisted PDT showed the highest success rate after treatment (88% in the combined group vs 76.5% in the FCO2 group and 64.7% in the PDT group) and the lowest recurrence rate after 6 months (no recurrent case in the combined group vs two cases in the FCO2 group and one case in the PDT group).
As regards side effects, pain, discoloration, slow growth, and paronychia were reported. Pain and discoloration were significantly lower in the FCO2 group than in the PDT and combined groups. However, slow growth was only shown in the FCO2 group in 4 patients and paronychia was only detected in the combined group in one patient.
Regarding satisfaction after treatment, patients who were treated with FCO2-assisted PDT were the most satisfied while patients in the PDT were the least satisfied after treatment.