A randomized comparative study of fractional carbon dioxide laser-assisted drug delivery with amorolfine versus amorolfine alone for the treatment of onychomycosis

Objective The study was done to compare the clinical efficacy rate, patient satisfaction, and side effects of fractional carbon dioxide (CO2) laser-assisted topical therapy with amorolfine versus amorolfine alone for the treatment of onychomycosis. Patients and methods In all, 100 patients were recruited for the study and were divided based on the lottery system into two groups. Group 1 (50 patients) received a combination of fractional CO2 laser and topical amorolfine (5%) and group 2 (n=50) received 5% amorolfine alone. The overall treatment efficacy was determined using clinical examination, onychoscopic pattern, and mycological clearance by comparing the infected area at baseline and 12 weeks after last treatment. Results Compared with group 2, clinical efficacy rate was significantly more in group 1 (22 vs. 0%, P<0.0001). Patient satisfaction rate was also higher in group 1 (64 vs. 6%, P<0.0001). Among the side-effects, mild pain was noted in group 1 with none in group 2 patients. Conclusion Fractional CO2 laser-assisted delivery of topical amorolfine (5%) therapy of onychomycosis showed a better clinical response than topical amorolfine (5%) alone. Fractional CO2 lasers may be explored further for use by standardizing the parameters and number of sessions to achieve better cure rates and thereby can replace systemic treatment.