Case report
Photodynamic therapy of onychomycosis caused by Trichophyton rubrum

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A combination of topical and oral antifungals is widely used to treat onychomycosis, but treatment failure is common and oral drugs may cause toxicity and potential drug interactions. For this reason, new approaches and strategies should be considered. The following case shows that photodynamic therapy (PDT) may represent an alternative noninvasive approach to treatment of onychomycosis.

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Case report

A 78-year-old woman presented with total onychomycosis of the right big toenail and proximal subungual onychomycosis of the left big toenail caused by Trichophyton rubrum (Fig 1). The patient had failed to respond to treatment with topical antifungals (potassium hydroxide [KOH] and cultures were positive after 18 months of use of amorolfine 5% nail lacquer) and had conditions that contraindicated administration of systemic antifungals (she was affected by hypertension and chronic hepatitis C

Discussion

The use of PDT has been recently extended from the oncologic field to that of antimicrobial chemotherapy.1, 2

In vitro studies have demonstrated that fungi can be effectively photosensitized after topical delivery of 5-aminolevulinic acid and killed at dose rates much lower than those that kill keratinocytes.3 Available information indicate that T rubrum, which is responsible for 90% of onychomycosis, is a possible target of PDT, as almost 50% of the fungal growth could be inhibited in vitro.4

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Supported by Ministero dell'Università e della Ricerca Scientifica e Tecnologica (MURST) University of Bologna.

Conflicts of interest: None declared.

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