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All Journal Journal of General Procedural Dermatology and Venereology Indonesia
Gaol, Evangelina Lumban
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Medicine & Pharmacology

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The effectiveness of laser therapy in onychomycosis patients: An evidence-based case report Prayogo, Rizky Lendl; Gaol, Evangelina Lumban; Azizah, Fitri; Lusiana, Lusiana; Rachmawati, Yenny; Rahman, Yusnita; Saldi, Siti Rizny
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 2, No. 1
Publisher : UI Scholars Hub

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Background: Onychomycosis may cause nail discoloration, thickening, nail bed separation, and other serious complications. For some cases, oral antifungal treatment is not tolerable because of its potential side effects and drug interactions. Laser therapy is considered as an alternative treatment, owing to the features of simple and effective, with only minor potential side effects. This EBCR was made to collect and appraise studies regarding the effectiveness of laser therapy for onychomycosis, and to suggest laser as an alternative treatment. Methods: Literature searching strategy was performed using Pubmed and Cochrane Library database to address the clinical problem. Keywords used were “laser” AND “onychomycosis”. Results: Seventy-nine articles were obtained from the search strategy procedure. After selection based on exclusion and inclusion criteria, and full-text availability, four relevant articles remained. Discussion: The study by Xu et al. was considered as the most valid study while compared to other three studies. This study used intention to treat analysis and had no loss of follow-up patients. Xu et al. compared mycological and clinical clearance rate between patients receiving laser, oral terbinafine, or combination of those two. It showed that laser therapy was less effective when compared to oral antifungal (Number Needed to Harm = 17). Conclusions: Laser has a lower level of effectiveness while compared to oral terbinafine as the current gold standard therapy for onychomycosis. However, laser therapy can still be used as an adjunctive therapy along with oral antifungal to achieve a better cure rate. More studies are needed to prove this hypothesis.
Dermoscopy and 30% potassium hydroxide direct examination as diagnostic tools for distal lateral subungual onychomycosis Gaol, Evangelina Lumban; Miranda, Eliza; Sirait, Sondang Pandjaitan
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 8, No. 2
Publisher : UI Scholars Hub

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Background: Culture and histopathological examination are gold standards for diagnosing onychomycosis. However, these examinations are subject to several limitations. Dermoscopy has the potential to become a promising diagnostic tool for onychomycosis. Direct examination of potassium hydroxide (KOH) also has advantages similar to dermoscopy. Knowing the accuracy of both examinations can help clinical decision-making. Our objectives are to assess the diagnostic value of dermoscopy, KOH examination, and their combination for distal lateral subungual onychomycosis compared to culture or histopathology. Methods: This was a cross-sectional diagnostic study of nails with suspected distal lateral subungual onychomycosis. Sixty nails were included in this study. Results: The sensitivity and specificity of the KOH examination were 89.6% and 66.7%, respectively. On dermoscopy, the sensitivity of jagged-edge-with-spikes, longitudinal striation, and discoloration were 89.6%, 93.8%, and 97.9%, respectively. Only the aurora borealis dermoscopic feature provided good specificity (91.7%). The positive predictive values of these four dermoscopic features were 75.0%–79.7%. Combination with KOH examination increased the positive predictive value of dermoscopy (90.9%–92.7%). Conclusion: Since they were superior in terms of sensitivity, dermoscopy and KOH examinations are good screening tools to determine which suspected onychomycosis cases need further examination. Additionally, an increased positive predictive value was observed when the two examinations were combined. Hence, these procedures can help establish a diagnosis in settings where mycologic examinations are unavailable.
Co-Authors Azizah, Fitri Lusiana Lusiana Miranda, Eliza Prayogo, Rizky Lendl Rachmawati, Yenny Rahman, Yusnita Saldi, Siti Rizny Sirait, Sondang Pandjaitan