Onychomycosis remains a common fungal infection of the nail. Laser and topical antifungal agent combination therapy are the newer treatment for onychomycosis. The present study systematically evaluated the efficacy and safety of a laser combined with a topical antifungal agent for treating onychomycosis.

It searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang and VIP databases from inception to November 2021 and included randomized controlled trials (RCTs) on laser therapy combined with topical antifungal agents for managing onychomycosis. It used the Cochrane Collaboration tool to assess the risk of bias and Revman 5.3 software in the meta-analysis.

The study observed:

• The inclusion of 12 studies involving 869 patients in the meta-analysis.
• Laser and topical antifungal agent combination therapy were superior to topical antifungal agents alone in terms of the complete cure rate, mycological cure rate, clinical effective rate and patient satisfaction rate.
• Both carbon dioxide (CO₂) laser combined with topical antifungal treatment and 1064-nm neodymium-doped:yttrium aluminum garnet (Nd:YAG) laser combined with topical antifungal therapy showed better outcome indicators, including mycological cure rate and clinical effective rate, than topical antifungal therapy alone. 
• No adverse events except for three studies reporting temporary burning sensation without treatment and mild to moderate pain, which were well-tolerated.

This study shows that laser and topical antifungal agent combination therapy is effective for onychomycosis. However, more large-scale and well-designed RCTs must confirm this.

Source: Zhang J, Lin P, Li J, et al. Efficacy of laser therapy combined with topical antifungal agents for onychomycosis: a systematic review and meta-analysis of randomized controlled trials. Lasers Med Sci. 2022;37(6):2557-69.