In the treatment of nail fungus, a combination of topical preparations and oral antifungal drugs is often prescribed. However, in some cases, alternative solutions to the problem have to be found, such as:
- When traditional treatment is ineffective
- When conventional treatment is not available (e.g. due to co-morbidities, liver damage, etc.)
- In case of adverse toxic effects of oral medications or interactions with other medications the patient is taking
One of the most effective alternative methods for treating nail fungus is photodynamic therapy. It is a local, non-invasive treatment method based on the interaction of certain chemicals and light, which results in the release of free radicals that destroy micro-organisms or target cells.
Photodynamic therapy (PDT) is a treatment using special light. The treatment is carried out in 2 stages: first, a photosensitive substance (photosensitiser) is applied to the affected area, and then the area is exposed to light of a specific wavelength. The interaction between the photosensitiser and the light results in the formation of oxygen free radicals and photochemical reactions that kill micro-organisms, fungal hyphae, spores and damaged cells. Cancer cells and micro-organisms have a different metabolism to healthy cells and absorb photosensitisers more intensively and rapidly, leading to more intense photochemical reactions and death. Healthy surrounding tissues remain intact because of the weak interaction between light and the photosensitiser.
Applications and indications for FDT
For a long time, the main application of photodynamic therapy has been in the treatment of tumours and precancerous conditions, not only of the skin but also of internal organs such as the oesophagus. However, after some time, it has been found to be effective for other skin problems, especially those of infectious or inflammatory origin. When can photodynamic therapy be prescribed?
- Skin cancers: actinic keratosis, basal cell carcinoma. Bowen’s disease, squamous cell carcinoma, Kaposi’s sarcoma, mycosis fungoides
- Psoriasis
- Viral skin diseases: warts, Herpes infection
- Acne
- Rejuvenation procedures
- Sebaceous gland hyperplasia
- Bacterial skin diseases: pyoderma, trophic ulcers
- Nail fungus, especially caused by T. rubrum
- Annular granuloma
- Pussy hidradenitis
- Hypertrophic scars, keloids
- Atrophic lichen planus
Preparation for the procedure
The procedure is simple and painless. Before the procedure, the nail plate must be specially prepared – flattened, softened, and thickened, as well as thickenings and subungual masses removed. This is done with a special abrasive or a 40% urea ointment. The thinner the nail plate, the better the penetration of the photosensitiser, thus increasing the effectiveness of the procedure. After the damaged nail has been properly prepared, the photosensitiser is applied to the nail and activated by light beams of a specific wavelength from dedicated devices.
Advantages of photodynamic therapy:
- Painless. There may be a slight tingling or warm sensation during the treatment, but this is temporary.
- There are no systemic toxic effects on the body.
- No interaction with other medications the patient is taking (e.g. antidepressants).
- The treatment is short (~30 minutes depending on the amount of nails treated) and can be followed by work and daily activities.
- Can be combined with other treatments and medications.
- Minimally invasive procedure, so that adjacent healthy tissues are not affected.
- Reduces the duration of systemic treatment by up to one third.
- Effective in the treatment of nail damage caused by T. rubrum.
- The micro-organisms do not become resistant to photodynamic therapy, so the effectiveness of the treatment does not diminish over time (in contrast to systemic therapy).
