Methylene blue‐mediated photodynamic therapy may be superior to 5% amorolfine nail lacquer for non‐dermatophyte onychomycosis

• Published in: Photodermatology, photoimmunology & photomedicine photoimmunology & photomedicine, 2021-05, Vol.37 (3), p.183-191
• Main Authors: Bowornsathitchai, Natthamon, Thammahong, Arsa, Shoosanglertwijit, Jittida, Kitsongsermthon, Jutarat, Wititsuwannakul, Jade, Asawanonda, Pravit, Boontaveeyuwat, Einapak
• Format: Article
• Language: English
• Subjects: amorolfine; antifungal; methylene blue; onychomycosis; photodynamic therapy
• ISSN: 0905-4383; 1600-0781
• DOI: 10.1111/phpp.12624

Background Methylene blue‐mediated photodynamic therapy as an antimicrobial has been reported to improve onychomycosis. Objectives To compare the short‐term efficacy of methylene blue‐mediated photodynamic therapy (MB‐PDT) and 5% amorolfine nail lacquer (AMO) for toenail onychomycosis using higher intensity and shorter total treatment period than previously reported. Methods Twenty‐seven toenails with onychomycosis were randomized to receive either six biweekly sessions of MB‐PDT or AMO for twelve weeks. Dermoscopic photography was used for onychomycosis severity index assessment under a dermoscopic inspection (d‐OSI) at baseline, weeks 6, 10, 14 and 22 as well as microscopic and microbiological tests. Adverse events were recorded. Results All subjects completed the study. Causative organisms found were exclusively non‐dermatophytes including Fusarium spp., Asperillus spp.,and yeasts. Fifteen toenails received MB‐PDT, whilst 12 received AMO. D‐OSI showed greater improvement in MB‐PDT than in AMO groups at weeks 6, 10, 14 as well as 22, with median changes of −2, −3, −4 (P = .055). and − 3 respectively in the MB‐PDT group. The AMO group displayed the median d‐OSI change of 0 throughout the study period. Mycological cure rate at 22 weeks in MB‐PDT and AMO group was 73.3% and 66.67% (P > .05). Clinical cure rate at 22 weeks in MB‐PDT (26.7%) was higher than AMO (16.7%), (P > .05). All patients only felt comfortably warm during the MB‐PDT treatment. No major adverse events were found in both groups. Conclusions MB‐PDT appeared to be more efficacious for non‐dermatophyte onychomycosis than AMO particularly in a limited period and moderately severe onychomycosis.