Harnessing Nd: Yag Laser Technology to Combat Antifungal Resistance in Yeast-Driven Onychomycosis Publisher Pubmed



Razaviyoun T ; Mansouri P ; Hashemi SJ ; Kamali Sarvestani H ; Nikkhah N ; Bkhshi H ; Razaviyoun S ; Mohajer B ; Rafat Z ; Ahmadikia K ; Hashemian Y
Source: Lasers in Medical Science Published:2025

Abstract

Onychomycosis is a persistent nail infection often caused by dermatophytes or yeasts, with conventional treatments limited by long durations, poor compliance, and resistance. The long-pulsed Nd: YAG 1064 nm laser (NDYL) has emerged as a potential adjunct; however, its effects in combination with antifungals against yeast-related cases are unclear. This study examined the in vitro synergistic effect of NDYL with four antifungal agents—Ketoconazole (KET), Itraconazole (ITK), Voriconazole (VRC), and Terbinafine(TRB)—on clinical yeasts isolates from patients with onychomycosis. Yeast isolates were identified through ITS PCR sequencing. Susceptibility testing was conducted using the CLSI disk diffusion method (document M44-A2). Two experimental series—vital nail scrapings and cultured colonies—were exposed to standardized NDYL laser parameters. Antifungal activity was assessed by measuring inhibition zone diameters, and statistical comparisons were performed using paired t-tests. NDYL significantly enhanced antifungal activity, with the most pronounced effects observed for KET and ITC (p < 0.05). KET achieved up to 100% sensitivity improvement in nail scraping samples. VRC and TRB demonstrated moderate but consistent enhancements. Recorded irradiation temperatures remained below 42 °C, suggesting primarily non-thermal mechanisms. The relative frequencies of increased inhibition zone diameters in nail scrapings, yeast colonies, and combined datasets were: ITC (83.3%, 50.0%, 66.7%), VRC (66.7%, 50.0%, 58.3%), TRB (33.3%, 16.7%, 25.0%), and KET (100%, 66.7%, 83.3%). These findings support NDYL as a potential adjunctive tool for enhancing antifungal efficacy in yeast-associated onychomycosis. Further in vivo research is warranted to confirm clinical applicability and refine treatment protocols. © The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature 2025.