الفهرس 
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Abstract
Onychomycosis (OM) is a challenging problem to both patient and physician. The patient suffers from a disease that reduces his quality of life while the physician struggle with long time, expensive treatments with many side effects and drug interactions that can harm the patient. The primary aim of treatment is to eradicate the organism as demonstrated by microscopy and culture. This is defined as the primary end-point. Clinical improvement and clinical cure are secondary end-points based on a strict scoring system of clinical abnormalities in the nail apparatus also, important goals are to reduce morbidity and to prevent complications.
Device-based therapies for onychomycosis treatment include four categories of device-based treatments: laser devices, photodynamic therapy, iontophoresis and ultrasound. Laser treatment of onychomycosis infections uses the principle of selective photothermolysis while photodynamic therapy is based on the usage of photosensitizing agents and light with exact wavelength. Singlet oxygen is generated, leading to cell death.
We conducted a right-left controlled prospective study, on 21 patients with at least 2 toenails onychomycosis in the same patient. These patients were recruited from outpatient clinic of dermatology department at Ain Shams University Hospitals. The study was conducted during the period from December 2016 till June 2018. Twenty-one patients (4 males and 17 females) with clinical signs of toenail onychomycosis were enrolled in the study. The diagnosis was confirmed via laboratory studies.
Onychomycosis Severity Index (OSI) used to measure the severity of OM. Patients were clinically assessed before treatment, monthly during the treatment administration and then 3 months after completion of treatment. The patients with confirmed onychomycosis were subjected to treatment. The right toenail was treated with PDT alone, whereas the left toenail was treated using fractional CO2 assisted PDT. The sessions were carried out every two weeks for a total of 6 sessions over 3 months. The patients were followed up for 3 months after completion of the study.
In our study, we found that Aspergillus species were the most common causative organisms of OM followed by Candida species and this is possibly because the non NDMs are more frequent in tropical and subtropical areas with a hot and humid climate.
Conventional PDT and fractional CO2-assisted PDT have an antifungal activity as manifest by a mycological cure rate of 57.1% and 76.2% in OM cases respectively. Fractional CO2-assisted PDT was superior to conventional PDT as regards the clinical improvement in nail appearance and patient satisfaction.