Case Report/Research Letter
Fast elimination of onychomycosis by hematoporphyrin derivative-photodynamic therapy

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Summary

Onychomycosis is a fungal nail disease and is one of the major onychopathy worldwide. Topical or oral antifungal therapies are used to treat this disease, but often they are inefficient and oral medications can even cause several side effects. Photodynamic therapy (PDT) is a well established technique and hence, may represent an alternative non invasive technique for the treatment of onychomycosis. In this work, we present a case of onychomycosis that was completely cured by using the porphyrin–photodynamic therapy. A 59-year-old patient, who had two nails with onychomycosis (the right and the left hallux, with more than thirty and ten years, respectively) caused by fungi was treated once a week for a period of six weeks. The nails were first treated and prepared by a specialist. An hour after the photosensitization, the nail was illuminated using a light source based on light emitting diodes (LEDs) in the red wavelength (630 nm, at a total dose of 54 J/cm2).

Section snippets

Background

The drugs usually indicated to treat ringworm of the nails are topical ointments, solutions or glazes. More difficult cases require treatment using oral tablets, and once the organisms become resistant, due to the slow growth of the nails, improvement is then slow. Nails can take up to 12 months to completely renovate and any treatment should be maintained throughout this whole period of time [1]. Persistence is key to conventional treatment which requires a long follow-up, and the type of

Case study

We conducted this study with a patient (male, 59 years old) with nail diseases caused by fungus. This patient had the lesions for approximately 30 (right hallux) and 10 (left hallux) years and was treated with the solution Photogem®. Approval of the University Ethical Committee was obtained as required (79th Ethics Committee Meeting on November 16, 2010). The patient had not responded to oral treatment with fluconazole, and was positive for the laboratory cultures indicating the presence of

Discussion and conclusion

In this work we are presenting a new clinical trial using porphyrin and a homemade device anatomically designed for the treatment of the onychomycosis. This work represents part of a complete research that compares two different photosensitizers and involves around 90 patients. Other compound photoactivated at 450 nm is being evaluated and we are working to present the results soon. The in vitro studies such as confocal microscopy are ongoing to understand the photodynamic inactivation

Acknowledgements

This work has been supported by grants from Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP; CEPOF Grant No. 98/14270-8) and Financiadora de Estudos e Projeto FINEP-Gnatus (Grant No. 554339/2010-2). APS was supported by a Conselho Nacional de Desenvolvimento Científico e Tecnológico fellowship (CNPq FINEP-Gnatus; Grant No. 381132/2010-2).

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