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PDT seems to be a good alternative treatment option for onychomycosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare the efficacy of combined therapies based on oral terbinafine (TN) plus adjunctive PDT mediated by methylene blue (MB) (TN\u00a0+\u00a0MB\/PDT) or methyl aminolevulinate (MAL) (TN\u00a0+\u00a0MAL\/PDT) in the treatment of onychomycosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twenty patients affected by severe dermatophyte onychomycosis in the nails of the big toe (&gt;60% disease involvement of target nail) received oral TN for 12\u00a0weeks and concomitantly were randomly allocated to receive nine sessions, separated by 2\u2010week intervals, of urea (40%) plus a PDT protocol mediated by MB (TN\u00a0+\u00a0MB\/PDT: group I) or mediated by MAL (TN\u00a0+\u00a0MAL\/PDT: group II). Clinical and mycological efficacy was evaluated at 16\u2010, 40\u2010 and 52\u2010week follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Both protocols showed a significant decrease in Onychomycosis Severity Index (OSI) scores (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.05), from 24.2\u00a0\u00b1\u00a04.6 to 0.7\u00a0\u00b1\u00a00.6 (group I)) and from 18.5\u00a0\u00b1\u00a010.1 to 2.1\u00a0\u00b1\u00a02.0 (group II). No side effects or complications were reported in any of the combinations used. Mycological cure rates were significantly higher during the last third of the evaluated period of time, reaching 100% and 90% in group I and group II, respectively, at the 52\u2010week follow\u2010up. In both modalities, complete cure was achieved in 70% of the patients at the 52\u2010week follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>TN\u00a0+\u00a0MB\/PDT and TN\u00a0+\u00a0MAL\/PDT show similar outcomes in the treatment of toenails with severe onychomycosis. PDT is an effective method to accelerate the TN\u2010mediated healing process.<\/jats:p><\/jats:sec>","DOI":"10.1111\/myc.13125","type":"journal-article","created":{"date-parts":[[2020,6,7]],"date-time":"2020-06-07T14:30:11Z","timestamp":1591540211000},"page":"859-868","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Methylene blue vs methyl aminolevulinate photodynamic therapy in combination with oral terbinafine in the treatment of severe dermatophytic toenail onychomycosis: Short\u2010 and long\u2010term effects"],"prefix":"10.1111","volume":"63","author":[{"given":"Enrique","family":"Alberdi","sequence":"first","affiliation":[{"name":"Private clinic of Dr. Alberdi Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5265-2233","authenticated-orcid":false,"given":"Clara","family":"G\u00f3mez","sequence":"additional","affiliation":[{"name":"Institute of Physical Chemistry Rocasolano CSIC Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,6,29]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-3083.2005.01288.x"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2133.149.s65.4.x"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1529-8019.2007.00109.x"},{"issue":"3","key":"e_1_2_8_5_1","first-page":"253","article-title":"Clinical insights about onychomycosis and its treatment: a consensus","volume":"17","author":"Hanna S","year":"2018","journal-title":"J Drugs Dermatol"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.0933-7407.2003.00933.x"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2133.2003.05242.x"},{"key":"e_1_2_8_8_1","doi-asserted-by":"crossref","unstructured":"Kreijkamp\u2010KaspersS HawkeK GuoL KerinG et al.Oral antifungal medication for toenail onychomycosis. 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