{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T07:34:27Z","timestamp":1766388867195,"version":"3.48.0"},"reference-count":29,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,20]],"date-time":"2025-12-20T00:00:00Z","timestamp":1766188800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infectious Disease Reports"],"abstract":"<jats:p>Background: Onychomycosis is a common nail infection primarily caused by Trichophyton rubrum, posing therapeutic challenges due to poor antifungal penetration and high recurrence rates. Conventional treatments include topical and systemic antifungals, but novel approaches such as laser therapy and chemical agents like nitric acid have emerged as promising alternatives or adjuncts. However, comparative evidence regarding the clinical and mycological efficacy of these treatments remains limited. Objectives: We aimed to assess and compare the clinical and mycological efficacy of three therapeutic modalities\u201469% nitric acid, 1064 nm Nd:YAG laser, and their combination\u2014in the treatment of Trichophyton rubrum onychomycosis over a 12-month follow-up period. Methods: A prospective, comparative, observational study was conducted, assigning patients with confirmed onychomycosis to one of three treatment groups: nitric acid, Nd:YAG 1064 nm laser, or combination therapy. Clinical and mycological cure rates, mean time to clinical resolution, changes in Onychomycosis Severity Index [OSI] scores, and mycological relapse rates were assessed over a 12-month follow-up. Results: All three groups demonstrated significant improvement in both clinical and mycological cure rates, with the combination therapy yielding the most favorable outcomes in terms of response speed and durability. Laser and nitric acid monotherapies were also effective, though associated with lower cure rates and longer times to resolution. The relapse rate was lowest in the combination group. Conclusions: The combination of nitric acid and Nd:YAG laser appears to be a more effective therapeutic option for Trichophyton rubrum onychomycosis, offering superior clinical and mycological outcomes compared to monotherapies, with faster resolution and lower relapse rates. These findings suggest that combination therapy may optimize the management of this challenging nail infection.<\/jats:p>","DOI":"10.3390\/idr18010001","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T07:01:33Z","timestamp":1766386893000},"page":"1","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative Retrospective Evaluation of the Clinical and Mycological Efficacy of 69% Nitric Acid, 1064 nm Nd:YAG Laser, and Their Combination in the Treatment of Trichophyton rubrum Onychomycosis over a 12-Month Follow-Up"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6181-870X","authenticated-orcid":false,"given":"Raquel","family":"Garc\u00eda De La Pe\u00f1a","sequence":"first","affiliation":[{"name":"Department of Podiatry, University of Seville, 41009 Seville, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2751-2132","authenticated-orcid":false,"given":"Jos\u00e9 Mar\u00eda","family":"Ju\u00e1rez-Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Department of Podiatry, University of Seville, 41009 Seville, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2256-5390","authenticated-orcid":false,"given":"Jo\u00e3o Miguel","family":"Costa Martiniano","sequence":"additional","affiliation":[{"name":"Portuguese Red Cross Higher School of Health, University of Lisbon, 1350-125 Lisbon, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9956-6263","authenticated-orcid":false,"given":"Ana Mar\u00eda","family":"Rayo P\u00e9rez","sequence":"additional","affiliation":[{"name":"Department of Podiatry, University of Seville, 41009 Seville, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.cpm.2016.02.001","article-title":"Onychomycosis: Evaluation, treatment options, managing recurrence, and patient outcomes","volume":"33","author":"Vlahovic","year":"2016","journal-title":"Clin. Podiatr. Med. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1097\/WON.0000000000000556","article-title":"Onychomycosis: Diagnosis, treatment, and prevention","volume":"46","author":"Beuscher","year":"2019","journal-title":"J. Wound Ostomy Cont. Nurs."},{"key":"ref_3","first-page":"494","article-title":"Pathophysiology and management of onychomycosis and novel approaches for effective transdermal applications","volume":"27","author":"Dharmian","year":"2023","journal-title":"Int. J. Pharm. Compd."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1111\/ijd.13690","article-title":"Examining the importance of laboratory and diagnostic testing when treating and diagnosing onychomycosis","volume":"57","author":"Ghannoum","year":"2018","journal-title":"Int. J. Dermatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.2147\/CCID.S362635","article-title":"Updated perspectives on the diagnosis and management of onychomycosis","volume":"15","author":"Falotico","year":"2022","journal-title":"Clin. Cosmet. Investig. Dermatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1016\/j.jaad.2018.05.1260","article-title":"Onychomycosis: Treatment and prevention of recurrence","volume":"80","author":"Lipner","year":"2019","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1177\/0897190016660487","article-title":"Tavaborole, efinaconazole, and luliconazole: Three new antimycotic agents for the treatment of dermatophytic fungi","volume":"30","author":"Saunders","year":"2017","journal-title":"J. Pharm. Pract."},{"key":"ref_8","first-page":"24","article-title":"Treatment options for onychomycosis: Efficacy, side effects, adherence, financial considerations, and ethics","volume":"17","author":"Yousefian","year":"2024","journal-title":"J. Clin. Aesthet. Dermatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1080\/13543776.2023.2268278","article-title":"Therapeutic treatment strategies for the management of onychomycosis: A patent perspective","volume":"33","author":"Chakraborty","year":"2023","journal-title":"Expert. Opin. Ther. Pat."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"104640","DOI":"10.1016\/j.pdpdt.2025.104640","article-title":"Antimicrobial photodynamic therapy in onychomycosis management: A systematic review of clinical trials","volume":"54","author":"Alves","year":"2025","journal-title":"Photodiagnosis Photodyn. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1111\/jdv.13798","article-title":"Treating onychomycosis with the short-pulsed 1064-nm Nd:YAG laser: Results of a prospective randomized controlled trial","volume":"31","author":"Karsai","year":"2017","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e17948","DOI":"10.1097\/MD.0000000000017948","article-title":"Laser treatment for onychomycosis: A systematic review and meta-analysis","volume":"98","author":"Ma","year":"2019","journal-title":"Medicine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1177\/1203475416677722","article-title":"Lasers for onychomycosis","volume":"21","author":"Gupta","year":"2017","journal-title":"J. Cutan. Med. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"167","DOI":"10.3109\/09546634.2015.1066479","article-title":"The future of lasers in onychomycosis","volume":"27","author":"Gupta","year":"2016","journal-title":"J. Dermatol. Treat."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"100949","DOI":"10.1016\/j.mycmed.2020.100949","article-title":"Treatment and management strategies of onychomycosis","volume":"30","author":"Aggarwal","year":"2020","journal-title":"J. Mycol. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2557","DOI":"10.1007\/s10103-022-03561-9","article-title":"Efficacy of laser therapy combined with topical antifungal agents for onychomycosis: A systematic review and meta-analysis of randomised controlled trials","volume":"37","author":"Zhang","year":"2022","journal-title":"Lasers Med. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2333","DOI":"10.1111\/jocd.13291","article-title":"Randomized controlled trial comparing long-pulsed 1064-nm Nd:YAG laser alone, topical amorolfine nail lacquer alone, and a combination for nondermatophyte onychomycosis treatment","volume":"19","author":"Bunyaratavej","year":"2020","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Marcos-Tejedor, F., Santos-Carnicero, N., and Mayordomo, R. (2021). Preliminary evidence of the efficacy of nitric acid treatment in onychomycosis. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182413371"},{"key":"ref_19","first-page":"75","article-title":"Efficacy and safety of 1064-nm Nd:YAG laser in treatment of onychomycosis","volume":"27","author":"Wanitphakdeedecha","year":"2016","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1111\/jocd.14233","article-title":"Big toenail onychomycosis features associated with response to 1064 nm Nd:YAG laser treatment","volume":"21","author":"Helou","year":"2022","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1007\/s10103-024-03992-6","article-title":"A focused review on laser- and energy-assisted drug delivery for nail disorders","volume":"39","author":"Konisky","year":"2024","journal-title":"Lasers Med. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1111\/jdv.13593","article-title":"Laser therapies for onychomycosis\u2014Critical evaluation of methods and effectiveness","volume":"30","author":"Francuzik","year":"2016","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_23","first-page":"e59720","article-title":"Efficacy of laser therapy in comparison with other methods for the treatment of onychomycosis: A systematic review and meta-analysis","volume":"16","author":"Meretsky","year":"2024","journal-title":"Cureus"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1016\/j.jaad.2020.05.143","article-title":"Effect of onychomycosis and treatment on patient-reported quality-of-life outcomes: A systematic review","volume":"85","author":"Stewart","year":"2021","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"968","DOI":"10.12688\/f1000research.18646.1","article-title":"Recent advances in therapies for onychomycosis and its management","volume":"8","author":"Gupta","year":"2019","journal-title":"F1000Research"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1080\/14740338.2020.1829592","article-title":"Safety of current therapies for onychomycosis","volume":"19","author":"Ricardo","year":"2020","journal-title":"Expert. Opin. Drug Saf."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1007\/s10103-020-03054-7","article-title":"Comparison of a fractional 2940-nm Er:YAG laser and 5% amorolfine lacquer combination therapy versus a 5% amorolfine lacquer monotherapy for the treatment of onychomycosis: A randomized controlled trial","volume":"36","author":"Zhang","year":"2021","journal-title":"Lasers Med. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1007\/s10103-023-03804-3","article-title":"Comparative study of safety and efficacy of combination therapy of fractional CO2 laser and topical amorolfine cream versus oral itraconazole in the treatment of onychomycosis","volume":"38","author":"Shetty","year":"2023","journal-title":"Lasers Med. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1111\/ijd.15869","article-title":"Combination of a triple wavelength [650 nm, 810 nm, and 915 nm] class IV laser system and local mechanical abrasion in the treatment of chronic toenail onychomycosis: An uncontrolled prospective pilot study","volume":"61","author":"Aukstikalnyte","year":"2022","journal-title":"Int. J. Dermatol."}],"container-title":["Infectious Disease Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7449\/18\/1\/1\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T07:30:54Z","timestamp":1766388654000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7449\/18\/1\/1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,20]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["idr18010001"],"URL":"https:\/\/doi.org\/10.3390\/idr18010001","relation":{},"ISSN":["2036-7449"],"issn-type":[{"value":"2036-7449","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,20]]}}}