La terapia láser como tratamiento de elección en la onicomicosis del pie diabético. Revisión de alcance

Abstract

Introduction: The patient with diabetic foot or at risk of suffering from it, is often prone to the invasion and proliferation of opportunistic microorganisms, being the onychomycosis (fungal infection of the nail) one of the dermatological infections more difficult to eradicate in this type of patients. In turn, the conventional treatment (topical antifungals, oral or systemic) can cause drug interactions and undesirable side effects, so that the laser therapy emerges as a good alternative for eliminating the onychomycosis in diabetic patients. Objective: To know the current evidence and clinical practice on the effectiveness of laser therapy as a treatment of choice in the onychomycosis in relation with the diabetic foot. Methodology: Study of bibliographic review and narrative synthesis. Systematic search of all kinds of papers and documents indexed in PubMed, EMBASE and free search, according to the criterion prism. Review period between 2005-2015. Selection and critical reading structured by the method of Lopez.Alonso and Galvez-Toro. Quality assessment of the evidence and recommendations by the scale of the AATM and NICE. Results: Critical reading of six selected papers: one randomized clinical trial (RCT) of double-blind, one clinical practice guideline (CPG) based on a systematic review with meta-analysis (SR), three bibliographic reviews of narrative synthesis, and 1 clinical case. Conclusions: The reliability and effectiveness of laser treatment in the diabetic foot for the resolution of the onychomycosis has not yet been demonstrated conclusively, so that there is not still a recommendation based on the evidence with enough power to allow generalizing their use. In addition, it is also the case that there is not a standardized protocol for its implementation, which generates certain clinical variability and uncertainty among professionals to apply such therapy, with high possibility of putting patient safety at risk.