ΡΑ LASER ΠΡΖΛ ΘΔΟΑΞΔΗΑ ΡΖΠ ΝΛΣΝΚΘΖΡΗΑΠΖΠ ΚΘΝΠ Ζ ΞΟΑΓΚΑΡΗΘΝΡΖΡΑ

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1 ΡΑ LASER ΠΡΖΛ ΘΔΟΑΞΔΗΑ ΡΖΠ ΝΛΣΝΚΘΖΡΗΑΠΖΠ ΚΘΝΠ Ζ ΞΟΑΓΚΑΡΗΘΝΡΖΡΑ ΛΗΘΝΙΑΝΠ Γ. ΘΑΙΝΓΔΟΝΞΝΙΝΠ MD ΓΔΟΚΑΡΝΙΝΓΝΠ ΑΦΟΝΓΗΠΗΝΙΝΓΝΠ

2 ΓΗΑΡΗ ΠΡΟΝΦΖ ΞΟΝΠ ΡΑ LASER? ΑΜΖΚΔΛΖ ΠΣΛΝΡΖΡΑ ΔΚΦΑΛΗΠΖΠ ΝΛΣΝΚΘΖΡΗΑΠΖΠ (2-8%) ΚΔΡΟΗΑ ΑΞΝΡΔΙΔΠΚΑΡΗΘΝΡΖΡΑ ΘΙΑΠΠΗΘΩΛ ΘΔΟΑΞΔΗΩΛ ΠΣΛΖ ΞΝΡΟΝΞΖ (20-25%) ΑΜΖΚΔΛΖ ΑΛΡΝΣΖ ΠΡΑ ΦΑΟΚΑΘΑ

3 ΞΟΝΦΗΙ ΑΠΘΔΛΝΠ ΘΑΗ ΞΑΟΔΛΔΟΓΔΗΔΠ ΦΑΟΚΑΘΩΛ ΑΙΙΖΙΔΞΗΓΟΑΠΔΗΠ ΦΑΟΚΑΘΩΛ ΚΑΘΟΝΣΟΝΛΖ ΓΗΑΟΘΔΗΑ ΞΑΟΣΝΠΩΛ ΘΔΟΑΞΔΗΩΛ ΚΔΗΩΚΔΛΖ ΠΚΚΝΟΦΩΠΖ ΑΠΘΔΛΩΛ

4 Ζ ΑΛΡΝΣΖ ΡΩΛ ΚΘΖΡΩΛ ΔΗΛΑΗ ΔΜΑΗΟΔΡΗΘΑ ΑΛΘΔΘΡΗΘΝΗ ΠΔ ΑΘΟΑΗΔΠ ΞΔΟΗΒΑΙΙΝΛΡΗΘΔΠ ΠΛΘΖΘΔΠ ΠΡΝΠ 4 Ν C ΓΗΑ 3 ΔΡΖ ΠΡΝΠ -70 Ν C ΓΗΑ 6 min ΠΡΝΠ +55 Ν C ΓΗΑ 10 min ΠΡΝΠ +124 Ν C ΓΗΑ 3 min

5 ΚΖΣΑΛΗΠΚΝΠ ΓΟΑΠΖΠ ακόμα ςπό διεπεύνηζη

6 ΚΘΖΡΝΘΡΝΛΝΠ η ΚΘΖΡΝΠΡΑΡΗΘΖ ΓΟΑΠΖ ΘΔΟΚΝΙΠΖ ΓΗΑΡΖΟΖΠΖ Ρ>55 ο C ΓΗΑ >10min ΚΔ ΑΞΝΡΔΙΔΠΚΑ ΑΚΚΔΠΖ ΘΑΡΑΠΡΟΝΦΖ ΔΞΑΓΩΓΖ ΑΛΝΠΝΙΝΓΗΘΖΠ ΑΛΡΗΓΟΑΠΖΠ

7 ΚΘΖΡΝΘΡΝΛΝΠ η ΚΘΖΡΝΠΡΑΡΗΘΖ ΓΟΑΠΖ ΓΖΚΗΝΟΓΗΑ ΘΔΛΝ ΠΞΖΙΑΗΩΠΖΠ (microcavitation) ΘΑΗ ΔΞΑΓΩΓΖ ΑΘΝΠΡΗΘΩΛ ΘΚΑΡΩΛ

8 ΚΘΖΡΝΘΡΝΛΝΠ η ΚΘΖΡΝΠΡΑΡΗΘΖ ΓΟΑΠΖ ΔΞΑΓΩΓΖ ΘΡΡΑΟΗΘΖΠ ΑΞΝΞΡΩΠΖΠ ΚΔΠΩ ΞΑΟΑΓΩΓΖΠ ΔΙΔΘΔΟΩΛ ΟΗΕΩΛ ΝΜΓΝΛΝ (DIODE LASERS)

9 ΚΘΖΡΝΘΡΝΛΝΠ η ΚΘΖΡΝΠΡΑΡΗΘΖ ΓΟΑΠΖ ΔΘΙΔΘΡΗΘΖ ΑΞΝΟΟΝΦΖΠΖ ΑΞΝ ΡΗΠ ΣΟΩΠΡΗΘΔΠ (ξανθομενίνη & μελανίνη 532nm/1064nm) ΘΑΘΩΠ ΘΑΗ ΑΞΝ ΡΝ ΘΡΝΣΟΩΚΑ C ΘΑΗ ΡΑ ΙΗΞΗΓΗΑ ΡΝ ΘΡΡΑΟΗΘΝ ΡΝΗΣΩΚΑΡΝΠ (Tr. Rubrum 930nm/870nm)

10 ΚΘΖΡΝΘΡΝΛΝΠ η ΚΘΖΡΝΠΡΑΡΗΘΖ ΓΟΑΠΖ ΝΗ ΚΘΖΡΗΘΔΠ ΦΔΠ ΚΞΝΟΝΛ ΛΑ ΘΑΡΑΠΡΟΑΦΝΛ ΚΔ ΞΑΟΑ ΞΝΙ ΚΗΘΟΝΠ ΣΟΝΛΝΠ ΞΑΙΚΝ 532, 694 & 1064 q/s-lasers

11 ΡΝ FDA ΔΣΔΗ ΓΩΠΔΗ ΔΓΘΟΗΠΖ ΓΗΑ LASER ΘΔΟΑΞΔΗΑ ΝΛΣΝΚΘΖΡΗΑΠΔΩΛ ΑΙΙΑ ΚΟΛΟ Ω ΠΡΟ ΣΖΛ ΑΦΑΙΔΗΑ ΡΝ FDA ΔΞΗΠΖΠ ΑΛΑΦΔΟΔΗ ΝΡΗ Ζ ΘΔΟΑΞΔΗΑ ΚΔ LASER ΞΟΝΠΦΔΟΔΗ ΠΡΟΩΡΗΛΖ ΚΟΛΟ ΒΔΙΣΗΩΖ ΡΖΠ ΔΚΦΑΛΗΠΖΠ-ΘΑΘΑΟΠΖΠ ΡΩΛ ΝΛΣΩΛ Theodore Rosen, Prof. of Dermatology Baylor college of Medicine, Houston AAD meeting 2012, San Diego, California

ΚΟΛΟ ΒΔΙΣΗΩΖ ΡΖΠ ΔΚΦΑΛΗΠΖΠ-ΘΑΘΑΟΠΖΠ ΡΩΛ ΝΛΣΩΛ Theodore Rosen, Prof.

12 IN VITRO Vural et al (2008) Nd:YAG Qs 1064 at 4 and 8 J/c Qs 532 at 8 J/cm2 Slowdown in culture growth rate (Tr.rubrum)

13 IN VITRO Hees et al (2012) Nd:YAG Qs 1064 at 4 and 8 J/cm2 Qs 532 at 8 J/cm2 Long pulse at 45 and 100 J/cm2 NO effect

14 IN VITRO Aguilar G et al. (2010) Nd:YAG Q-switched 1320nm Combined with thermal shock and negative pressure Slowdown in culture growth rate (Tr.rubrum)

15 IN VITRO Bronstein et al (2009) Cobination of 870 and 930 nm (CW Diode laser) Fungicidal (Tr.rubrum και C.albicans)

16 IN VITRO Manevitch (2010) Ti-sapphire femtosecond 800nm Fungicidal (Tr.rubrum cultures)

17 Laser therapy for onychomycosis Gupta AK, Simpson FC J CUTAN SURG 2013 SEP-OCT;17(5): Ζ LASER ΘΔΟΑΞΔΗΑ ΔΣΔΗ ΔΓΘΟΗΘΔΗ ΚΟΛΟ ΓΗΑ ΣΖΛ ΘΟΚΔΣΟΙΟΓΗΘΖ ΘΑΘΑΡΖ ΣΟΤ ΛΤΥΗΟΤ ΘΑΗ ΟΥΗ ΓΗΑ ΣΖΛ ΔΘΡΗΕΩΖ ΣΟΤ ΚΤΘΖΣΑ ΓΔΛ ΚΠΟΡΔΗ ΛΑ ΠΡΟΣΑΘΔΗ Ω ΘΔΡΑΠΔΗΑ ΔΘΡΗΕΩΖ ΡΝ ΚΘΖΡΑ ΘΑΗ ΑΞΑΗΡΝΛΡΑΗ ΞΔΟΗΠΠΝΡΔΟΔΠ ΚΔΙΔΡΔΠ ΩΠ ΞΟΝΠ ΡΖΛ ΑΞΝΡΔΙΔΠΚΑΡΗΘΝΡΖΡΑ

Ζ LASER ΘΔΟΑΞΔΗΑ ΔΣΔΗ ΔΓΘΟΗΘΔΗ ΚΟΛΟ ΓΗΑ ΣΖΛ ΘΟΚΔΣΟΙΟΓΗΘΖ ΘΑΘΑΡΖ ΣΟΤ ΛΤΥΗΟΤ ΘΑΗ

18 IN VIVO ΣΟΖΠΗΚΝΞΝΗΝΚΔΛΝΗ ΞΑΟΑΚΔΡΟΝΗ 1. WAVELENGTH (infrared sprectrum > 700nm) NdYAG : 1064, 1320, 1540 nm Diode : 870, 930 nm 2. PULSE TIME: pulsed lasers TRT of nail unit = 1ms long pulse: ms (10-3) short pulse: μs(10-6), nanosec(10-9), femto (10-15)

19 IN VIVO ΣΟΖΠΗΚΝΞΝΗΝΚΔΛΝΗ ΞΑΟΑΚΔΡΟΝΗ 3. FREQUENCY (Hz = pulses /sec) 4. SPOT SIZE penetration increases using a larger spot size 1 10 mm 5. FLUENCE fluence = J/cm2 : J/cm2

20 FDA APPROVED LASERS

21 FDA APPROVED LASERS

23 Kojaref et al Novel laser therapy in treatment of onychomycosis J Laser Health Academy patients Trichophytum, Candida, Aspergillus NdYAG laser (Fotona) long pulse Priming with urea 40% three days pre-op Fluence of J/cm2 with pulse time of 35ms Three passes of 2 min each Temperature between Ν C 4 sessions with an interval of 7 days No relapse after 12-month follow up 100% Mycological Cure

25 The Effect of Q-Switched Nd:YAG 1064nm/532nm Laser in the Treatment of Onychomycosis In Vivo. Kalokasidis K1, Onder M2, Trakatelli MG3, Richert B4, Fritz K5. Dermatology Research and Practice; 2013 In this prospective clinical study, the Q-Switched Nd:YAG 1064nm/532nm laser (Light Age, Inc., Somerset, NJ, USA) was used on 131 onychomycosis subjects (94 females, 37 males; ages 18 to 68 years). Mycotic cultures were taken and fungus types were detected. The laser protocol included two sessions with a one-month interval. Treatment duration was approximately 15 minutes per session and patients were observed over a 3-month time period. Laser fluencies of 14J/cm(2) were applied at 9 billionths of a second pulse duration and at 5Hz frequency. Follow-up was performed at 3 months with mycological cultures. Before and after digital photographs were taken. Adverse effects were recorded and all participants completed "self-evaluation questionnaires" rating their level of satisfaction. All subjects were well satisfied with the treatments, there were no noticeable side effects, and no significant differences were found treating men versus women. At the 3-month follow-up 95.42% of the patients were laboratory mycologically cured of fungal infection. This clinical study demonstrates that fungal nail infections can be effectively and safely treated with Q-Switched Nd:YAG 1064nm/532nm laser. It can also be combined with systemic oral antifungals providing more limited treatment time.

26 Treatment of onychomycosis with a 1,064-nm long-pulsed Nd:YAG laser. Moon SH, Hur H, Oh YJ, Choi KH, Kim JE, Ko JY, Ro YS. J Cosmet Laser Ther Aug;16(4): doi: / Epub 2014 Apr 29. PMID: [PubMed - in process]

27 Treatment of onychomycosis with a 1,064-nm long-pulsed Nd:YAG laser. Moon SH1, Hur H, Oh YJ, Choi KH, Kim JE, Ko JY, Ro YS. Abstract Abstract Background: There are various treatment modalities of onychomycosis. Of these, however, oral antifungal therapies are complicated by potential drug interactions and systemic effects, and the surgical treatment can result in prolonged pain. Therefore, a new, safe and effective therapy is needed that can improve the aesthetic appearance of the nails. Objective: The purpose of this study was to evaluate the effect of treatment of onychomycosis with a 1,064-nm long-pulsed Nd:YAG laser. Methods: 13 patients (31 toenails, 12 fingernails) received five treatment sessions at 4-week intervals with a 1,064-nm long-pulsed Nd:YAG laser. Parameters for each treatment were 6 mm spot size, 5 J/cm(2) fluence, 0.3 ms pulse duration and 5 Hz pulse rate. Results: Of the 13 patients, 8 (61.5%) were women and 5 were men. The mean age of the patients was 62. Of the 43 nails, 4 (9.3%) achieved a complete cure (9.3%), 8 had excellent treatment outcomes (18.6%) and 31 had good treatment outcomes (72%). None of the 13 patients experienced any discomfort except for a mild burning sensation and there were no adverse effects. Conclusions: Our results demonstrate that the 1,064-nm long-pulsed Nd:YAG laser could be a safe and effective treatment modality in the management of patients with onychomycosis.

28 Toenail onychomycosis treated with a fractional carbon-dioxide laser and topical antifungal cream. Lim EH, Kim HR, Park YO, Lee Y, Seo YJ, Kim CD, Lee JH, Im M. J Am Acad Dermatol May;70(5): doi: /j.jaad Epub 2014 Mar 18.

29 Traditional pharmacotherapy for onychomycosis has low to moderate efficacy and may be associated with adverse reactions and medication interactions limiting its use in many patients. OBJECTIVE: We evaluated the clinical efficacy and safety of a fractional carbon-dioxide laser with topical antifungal therapy in the treatment of onychomycosis. METHODS: In all, 24 patients were treated with fractional carbon-dioxide laser therapy and a topical antifungal cream. Thelaser treatment consisted of 3 sessions at 4-week intervals. Efficacy was assessed based on the response rate from standardized photographs, a microscopic examination of subungual debris, and subjective evaluations. RESULTS: Among the patients, 92% showed a clinical response and 50% showed a complete response with a negative microscopic result. The factors that influenced a successful outcome were the type of onychomycosis and the thickness of the nail plate before treatment. The treatment regimen was well tolerated and there was no recurrence 3 months after the last treatment episode. LIMITATIONS: The study followed up only 24 patients and there were no relevant treatment controls. CONCLUSIONS: Fractional carbon-dioxide laser therapy, combined with a topical antifungal agent, was effective in the treatment of onychomycosis. It should be considered an alternative therapeutic option in patients for whom systemic antifungal agents are contraindicated.

30 The use of the Er:YAG 2940nm laser associated with amorolfine lacquer in the treatment of onychomycosis. Morais OO1, Costa IM, Gomes CM, Shinzato DH, Ayres GM, Cardoso RM. An Bras Dermatol Sep-Oct;88(5): doi: /abd

31 Abstract Onychomycosis is a common disease, accounting for up to 50% of all ungual pathologies. We have been developing a clinical trial (ClinicalTrials.gov: NCT ) using a 2940nm Er:YAG laser to fractionally ablate human nails in vivo, aiming to increase topical amorolfine lacquer delivery to the nail unit, increasing the efficacy of topical treatment of distal and lateral subungual onychomycosis. Partial results have shown an increase in areas of nail plate free of disease. We believe that ablative lasers can increase the efficacy of topical onychomycosis treatment.

32 ΠΚΞΔΟΑΠΚΑΡΑ In Vitro μελέηερ σωπίρ ανηίζηοιση in Vivo εθαπμογή In Vivo μελέηερ μη ηςσαιοποιημένερ, βπασςσπόνιερ και μη ζςγκπιηικέρ Ανάγκη για πιο έγκςπερ μελέηερ με μακποσπόνιο Follow-up και <<ζηανηάπιζμα>> παπαμέηπων

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