Emerging treatments

Laser treatment

One systematic review and meta-analysis reported mycological cure rates of 63% with 1064-nm Nd:YAG laser and 74.0% with CO₂ lasers in patients with onychomycosis.[60] A Cochrane review reported that treatment with 1064‐nm Nd:YAG laser therapy may be of little or no difference to sham treatment or no treatment with respect to mycological cure at 52 weeks.[61] Potential adverse effects include pain and bleeding.[60] More randomised controlled studies are required. 

Systemic second-generation azole antifungals

Reserved primarily for the treatment of invasive opportunistic fungal infections, particularly in immunocompromised patients. Second-generation triazoles (e.g., voriconazole, posaconazole, ravuconazole) have broad-spectrum antifungal activity. Clinical trials indicate efficacy in patients with onychomycosis.[62][63][64] The systemic bioavailability of fosravuconazole, a prodrug of ravuconazole, enables a short duration of therapy of 3 months.[64][65] Second-generation azoles may have a role in the management of onychomycosis resistant to standard antifungal agents. However, they are associated with rare but severe adverse effects.

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