Toenail fungus, also known as onychomycosis , is a common problem that can cause nails to become thick, yellow, and brittle. Although traditional treatments such as antifungal creams and pills are available, these can take months to work and, in some cases, don't work well.
A more modern and promising treatment is photodynamic therapy (PDT) , which uses a combination of light and special substances called photosensitizers to effectively kill fungus without serious side effects. In this article, we explain how two of these photosensitizers, methylene blue (MB) and flavin mononucleotide (FMN) , compare in fighting nail fungus.
What is Photodynamic Therapy (PDT) and How Does it Work?
Photodynamic therapy (PDT) is a treatment in which a special substance is applied to the nail and then activated with a specific light. This combination generates reactive molecules that destroy the fungus without damaging healthy tissue.
The advantages of PDT include:
✅ It does not cause serious side effects, unlike some oral antifungals.
✅ It does not require surgery or invasive treatments.
✅ It is a quick and well-tolerated procedure.
For PDT to work, choosing the right photosensitizer is key. In this case, we compare two options: methylene blue (MB) and flavin mononucleotide (FMN) .
Methylene Blue: How Does It Help Eliminate Fungus?
Methylene blue (MB) is a substance that has been used in medicine for many years. When applied to the nail and exposed to light, it releases molecules that attack and eliminate fungus.
What do the studies say?
🔹 In clinical studies, methylene blue has shown very promising results in eliminating nail fungus .
🔹 After several months of treatment, a significant reduction in the amount of fungus was observed, with success rates reaching up to 90% .
🔹 Patients treated with methylene blue showed visible improvement in the appearance of their nails within a period of 6 to 12 months.
This means that methylene blue may be an excellent option for treating onychomycosis without having to resort to aggressive treatments.
Flavin Mononucleotide: Is It an Effective Alternative?
Flavin mononucleotide (FMN) is another substance that has been studied as a photosensitizer in photodynamic therapy. Like methylene blue, FMN reacts with light to produce an antifungal effect.
However, studies have shown that methylene blue is more effective than FMN in eliminating toenail fungus .
Main differences between AM and FMN:
| Feature | Methylene Blue (MB) | Flavin Mononucleotide (FMN) |
|---|---|---|
| Effectiveness against fungi | High (up to 90%) | Moderate (less effective than AM) |
| Time for improvement | 6-12 months | Similar, but less successful in total elimination |
| Availability | Wide | Less common in commercial treatments |
These results indicate that methylene blue is the best option in photodynamic therapy for moderate onychomycosis .
Is Methylene Blue Photodynamic Therapy a Good Option for You?
If you suffer from toenail fungus and traditional treatments have not worked, methylene blue PDT may be an effective and safe alternative .
Advantages of this treatment:
✔️ It is less aggressive than oral antifungals.
✔️ It does not cause major side effects.
✔️ It has a high success rate.
✔️ It can be applied on an outpatient basis and is painless.
Protocol
Although protocols may vary across studies and clinical practices, a general protocol mentioned in research papers is described below:
-
Nail Evaluation and Preparation
- Clinical Evaluation: Confirm the diagnosis of onychomycosis by clinical analysis and, if possible, cultures or microscopic examinations.
- Local Preparation: Debridement (removal of the infected and thickened part) of the nail to facilitate penetration of the agent.
-
Application of Methylene Blue
- Concentration: A 1% methylene blue solution is used.
-
Procedure:
- Clean the affected area.
- Apply the solution evenly on the nail and perinail area.
-
Incubation time
- Allow the dye to act for 3 to 5 minutes to ensure adequate penetration into the affected tissue.
-
Light Activation (Photodynamic Therapy)
- Light Source: LED or laser light with a wavelength that activates methylene blue (usually in the 630–660 nm range) is used.
- Exposure: Light the nail for 10 to 15 minutes . Activation generates reactive oxygen species that help damage fungal cells.
-
Frequency and Number of Sessions
- Sessions: Generally 2 to 3 sessions are held per week .
- Duration of Treatment: Treatment may extend from 4 to 6 weeks or longer, depending on the clinical response and the extent of the infection.
-
Monitoring and Evaluation
- Periodic monitoring is essential to assess the response to treatment and adjust the protocol if necessary.
To take into account
- Protocol Adaptation: Concentrations, incubation times and light parameters may vary based on literature and clinical experience.
- Scientific Evidence: Although some studies show promising results, the efficacy and safety of this protocol may require further research to become a first-line treatment.
Conclusion
Onychomycosis is an annoying and difficult-to-treat condition, but photodynamic therapy with methylene blue is emerging as one of the most effective solutions .
Compared to flavin mononucleotide , methylene blue has been shown to be more effective in eliminating toenail fungus .
If you are looking for an innovative treatment, without serious side effects and with good results, PDT with methylene blue may be a great option for you.
Frequently Asked Questions (FAQ)
❓ How long does methylene blue therapy take to take effect?
In clinical studies, patients noticed visible improvements in 6 to 12 months , with a significant reduction in fungus.
❓ Is methylene blue treatment safe?
Yes, it is a safe and well-tolerated treatment, with no serious side effects.
❓ How many sessions of photodynamic therapy are needed?
The number of sessions depends on each case, but generally several sessions over several months are required to obtain the best results.
❓ Does methylene blue stain nails?
Yes, methylene blue can leave a temporary stain on the nail, but it fades over time.
