Efficacy and Safety of Topical Steroid with 1064 nm Long-pulsed Nd:YAG Laser compared to Topical Steroid Alone in the Treatment of Paronychia associated with EGFR Inhibitors: A Randomized Controlled Pilot Study

Abstract

Paronychia is a common adverse event associated with epidermal growth factor receptor inhibitor (EGFRI) therapy, substantially affecting patients’ quality of life and adherence to cancer treatment. Currently, there are no definitive guidelines for its management. This prospective randomized controlled study evaluated the efficacy and safety of a topical steroid combined with a long-pulsed 1064 nm Nd:YAG laser compared to topical steroids alone for treating paronychiae associated with EGFRIs. Each of the ten patients with two lesions (20 in total) was randomized to receive laser treatment with topical steroids on one lesion (n = 10), while the other lesion received topical steroids alone (n = 10). PSG grade, Atis grade, and pain scores were assessed at baseline (Day 0) and on Days 7, 14, and 21. Photographic documentation was obtained at each time point. The laser group demonstrated significantly greater improvements. The reduction in PSG grade from Day 0 to Day 21 was more pronounced in the laser-treated lesions (-1.40 ± 0.84) than in those treated with steroids alone (-0.50 ± 0.97, p = 0.045). The reduction in Atis grade was also greater in the laser group (-2.70 ± 0.82) than in the control group (-0.30 ± 1.70, p = 0.003). Pain reduction was also more significant in the laser group. Nd:YAG 1064 nm laser therapy combined with topical steroids demonstrates superior efficacy in reducing inflammation and pain in EGFRI-associated paronychia. This suggests that a combined treatment approach is a promising option. Further studies with larger sample sizes are warranted to confirm these findings.