Background: Onychomycosis treatment is still challenging as multiple treatment options are available but there is no fully curative or preventive treatment.
Objective: To evaluate the clinical and mycological efficacy of fractional carbon dioxide laser assisted delivery of topical tazarotene versus topical tioconazole in the treatment of onychomycosis.
Patients and methods: Forty patients with mycological confirmed onychomycosis. Patients were recruited From the Dermatology outpatient clinic at Al-Zahar, a University Hospital in the period from October 2019 to October 2020. Patients were randomly divided into two equal groups: First group was treated by fractional CO2 laser for 4 sessions at 3-weeks interval plus topical tazarotene 0.1% gel applied once a day on the affected nail plates and nail folds for 12 weeks, and second group was treated by both fractional CO2 laser for 4 sessions at 3-weeks interval plus topical tioconazole solution applied once a day on the affected nail plates and nail folds for 12 weeks. Patients were evaluated in terms of clinical improvement and mycological care. Treatment outcome was evaluated through physician's evaluation of improvement using physical examination in each follows up session, score clinical index of onychomycosis, and possible side effects.
Results: At the end of treatment, Fr CO2 + Tazarotin group, OSI became mild in 10%, moderate in 30%, and severe in 40% after treatment, while in Fr CO2 + Ticonazol group, it became mild in 40%, moderate in 10% and severe in 10% after treatment.
Conclusion: Fractional CO2 laser was expected to be an excellent choice for patients in whom systemic antifungals were contraindicated.