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Breaking the fungal biofilm with Q-switched Nd: YAG laser and black peel: species-blind nonpharmacological eradication of Azole-resistant onychomycosis
Joint Event on International Conference on Pathology and Infectious Diseases & 3rd International Conference on Pathology and Oncology Research
November 11-12, 2019 | Singapore
Amarendra Pandey
COSMASURE, India
Scientific Tracks Abstracts : J Infectious Disease Med Microbiol
Abstract:
Background: Onychomycosis (ONM), hitherto an easily
manageable problem, more commonly seen in elderly
patients has unfortunately transformed into an extremelydifficult-
to treat nail disorder, especially due to the widespread
azole resistance. Not only has the azole resistance become a
reason of treatment failure with itraconazole or ITRA (the
usual drug of choice), the azole-induced cross resistance
to oral terbinafine and topical amorolofine has rendered
ONM caused by dermatophytes, yeasts as well as molds to
Multi-Drug-Resistant (MDR) ONM, refractory to all forms
of pharmacological interventions. The problem is reaching
epidemic proportions in South Asian Countries. The use of
ITRA further becomes impossible in the elderly who are not
only on polypharmacy (owing to plethora of drug interactions
of ITRA), but also stemming from its absolute contraindication
in patients with any disease that has impaired or has the
potential to compromise the patient’s cardiac function.
However, ONM involving multiple nails in geriatric and
diabetic patients warrants complete treatment as it serves
as a source of recurrent tinea of the feet and other sites,
and even contributes to formation of diabetic foot ulcers.
Dermatologists across the Asia-Pacific are finding it difficult
to treat all forms of ONM, especially because most have been
rendered azole-resistant due to unscrupulous use of ITRA
with respect to wrong dosage, duration and dietary-intake
instructions due to wrong prescription by non-specialists and/
or self-use by the patients.
Focus: Physical therapies, especially Q switched Nd: YAG
and fractional lasers have been anecdotally reported to
provide gratifying results in ONM. However, their success
in eradication of proven MDR onychomycosis is lacking. In
my lecture, I shall be discussing the mechanism of action,
methodology, success rates, and mild precautions required
while treating MDR ONM with lasers, especially Q-switched
Nd: YAG laser. I would crystallize the concepts on exploiting
the latter’’s property of selective photo-thermolysis against
the fungal chromophore of xanthomegnin (532 nm) or
melanin (1064 nm), and thermal disruption of biofilms to
result in a cost-effective, species-blind high-efficacy, and
geriatric-safe approach to eradication of azole-resistant and
MDR onychomycosis. For colleagues who don’t have access
to this otherwise easily available and affordable device, I
shall dwell upon our team’s novel innovation of successful
repurposing of the Black Peel, a cosmetic peel for acne
and pigmentation consisting black acetic acid, salicylic acid,
tetrahydrojasmonic acid, bio sulphur, and potassium iodide
for successful treatment of ONM, in combination with topical
ciclopirox nail lacquer. The innovative use of chemical peel
for ONM, although requires multiple sessions, it offers an
excellent option in resource- and cost limited settings.
Conclusion: Q-switched laser and special chemical peels
offer a drugfree, extremely safe, convenient, and efficacious
option of successfully treating azole-resistant and MDR
onychomycosis. The knowledge and acquisition of these skills
have become essential for any practicing specialist in today’s
era of rampant drug-resistant pathogenic dermatophytic,
candida and mold infections.
Biography:
Amarendra Pandey is a Cosmetic Dermatovenereologist, Aesthetic Dermatologist and Dermatologist in Civil Lines, Jabalpur and has an experience of 7 years in these fields. He practices at Cosmasure in Civil Lines, Jabalpur. He completed DVD from DY Patil University in 2014, MBBS from Vikram University Ujjain in 2010 and MD - (Dermatology & STD) from University of Guyana Faculty of Health Sciences in 2015.
E-mail: a.pandey007@gmail.com
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