Supplementary Material for: Single session Fractional CO2 laser following Urea occlusion in management of onychomycosis - A pilot study

Introduction Onychomycosis is a common nail disorders. Antifungal resistance, interactions and side-effects limit treatment options. Fractional CO2 laser(FCO2) along with topical antifungal is effective in multiple monthly sessions. A modification reducing repeated visits and hence, better compliance is preferable. Single-session FCO2 laser following urea occlusion is reported to be effective. Thus, we conducted a study to determine the efficacy of single-session of FCO2 laser with 1%terbinafine cream with and without ‘urea cream occlusion’ in managing onychomycosis. Methods Prospective, randomized, parallel-group study conducted at a tertiary centre. Onychomycosis was confirmed by positive fungal mount and culture. Patients were randomized into 2-groups and administered single-session of FCO2 Laser. Group-A treated after overnight urea cream occlusion and Group-B without occlusion. Both groups applied 1%terbinafine cream twice daily for 3 months. Response was assessed by improvement in Onychomycosis Severity Index(OSI) at 6 months. Results Group-A had 10 patients, 14 nails. Clinical improvement was seen in 12/14(85.7%) nails. Average reduction in OSI was 10.78. Group-B had 10 patients, 11 nails. Clinical improvement was seen in 5/11(45.5%) nails. Average reduction in OSI was 1.73. ‘Reduction in OSI’ was statistically significant(P<0.05) only in group-A. Conclusion Single-session FCO2 laser following overnight Urea cream occlusion, followed by 1%terbinafine cream is effective for management of onychomycosis.