Effect of onychomycosis on quality of life

doi:10.1016/S0190-9622(98)70199-9

Journal of the American Academy of Dermatology

Volume 38, Issue 5, May 1998, Pages 702-704

https://doi.org/10.1016/S0190-9622(98)70199-9 Get rights and content

Abstract

Background: Onychomycosis impairs normal nail functions, causes considerable pain, interferes with daily activities, and has negative psychosocial effects. Objective: Our purpose was to determine patients’ perception of onychomycosis on the quality of life. Methods: A total of 258 patients with confirmed onychomycosis were surveyed by telephone at three centers. Responses to a standardized quality-of-life questionnaire were analyzed for patient demographics, physical and functional impact, psychosocial impact, and economic impact. Results: Highest positive responses were nail-trimming problems (76%), embarrassment (74%), pain (48%), nail pressure (40%), and discomfort wearing shoes (38%). Ability to pick up small objects was impaired in 41% of subjects with fingernail involvement. More than 58 onychomycosis-related sick days and 468 medical visits (1.8 per subject) were reported during a 6-month period. Conclusion: Onychomycosis has significant social, psychologic, health, and occupational effects. Relevance of quality-of-life issues to overall health, earning potential, and social functioning should prompt reconsideration of the value of aggressive treatment of and financial coverage for onychomycosis. (J Am Acad Dermatol 1998;38:702-4.)

Section snippets

PATIENTS AND METHODS

A total of 258 subjects were interviewed by questionnaire: 118 (46%) from Massachusetts General Hospital, 99 (38%) from Columbia University College of Physicians and Surgeons, and 41 (16%) from the University of Texas Medical Branch at Galveston. The subjects were generally healthy, had a median age of 51.5 years, and were predominantly white and male. Thirty-seven percent took prescription drugs daily, mostly for hypertension or for cardiac or pulmonary conditions. About half were employed in

RESULTS

The mean duration of nail fungal disease in the study population was 9.5 years. At the time of the interview, 227 subjects (88%) had active nail disease. More than half with fingernail disease and about 35% of those with toenail disease had had involvement of one to three nails. All 10 digits had been affected in 15% of subjects with fingernail and 28% of those with toenail involvement. Nearly 40% reported an associated fungal infection on the soles during the past 3 years.

Onychomycosis

DISCUSSION

Our subjects all volunteered for clinical trials on onychomycosis and were therefore a self-selected population likely to perceive their disease as significant. In addition, in our study, nail disease severity was judged by patients without reference to anything external (i.e., they could say their nails were severely affected, then separately and subsequently deny physical pain and discomfort and even functional and psychosocial problems). For these reasons, quality-of-life scores often do not

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In 2 studies, Szepietwoski et al22,23 reported poorer quality of life in patients who had fingernail and toenail involvement compared with those with only toenail onychomycosis. Drake et al17 reported that a greater proportion of patients with onychomycosis involving the fingernail were embarrassed by their nails compared with those with only toenail involvement. Conversely, Kayarkatte et al26 found that most patients with fingernail-only involvement reported a small effect on quality of life (Dermatology Life Quality Index score 1-5), whereas the majority of those with toenail-only involvement or fingernail and toenail involvement reported a moderate effect on quality of life (Dermatology Life Quality Index score 6-10).
Onychomycosis is the most common nail disorder, often causing physical, emotional, and aesthetic consequences. The effect of both the condition itself and treatment on quality of life has not been well studied.
The objectives of this study were to systematically review the available literature describing the effect of onychomycosis and treatment on quality of life.
We performed a search of the onychomycosis literature published before April 13, 2020. Articles were included in the review if primary data were presented, patient-reported outcome measures were used, and onychomycosis was specifically examined.
Thirty studies were included in the final analysis. Poorest quality-of-life scores were associated with women and fingernail involvement. Quality-of-life scores improved from baseline with all treatment types; there were greater improvements reported with oral treatments compared with topical ones.
This review affirms that onychomycosis significantly influences quality of life, warranting effective treatment. All treatments resulted in quality-of-life improvements; however, studies on oral and topical therapies were of higher quality than those evaluating devices. Increased efforts are needed to understand the effect of the disease and therapy as assessed by validated, nail-specific outcome measures that accurately assess patients' cosmetic, physical, and social difficulties.
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In this study, oxiconazole nitrate (OXI)-loaded antifungal thermosensitive chitosan/carboxymethylcellulose/scleroglucan/montmorillonite (CHT/CMC/SGL/MMT) nanocomposite hydrogels were developed for onychomycosis treatment. The presence of 5% (w/w) MMT within hydrogel matrix increased the glass transition temperature of CHT/CMC/SGL material from 63.72 °C to 76.75 °C and the compressive stress value from 126.45 ± 8.83 kPa to 266.99 ± 6.60 kPa. For the use of hydrogel materials in the treatment of onychomycosis, antifungal OXI drug was loaded into the network of thermosensitive CHT/CMC/SGL and CHT/CMC/SGL/MMT hydrogels and the release of OXI from these materials was monitored spectrophotometrically. At the end of 420 min, for hydrogel systems containing 0, 1, 3 and 5 % (w/w) MMT, OXI release amounts were determined as 70.33 ± 1.74 %, 63.92 ± 0.31 %, 58.78 ± 1.45 % and 52.89 ± 0.21 %, respectively. This means that the drug release depends on the MMT amount within hydrogel matrix and can be controlled by changing the amount of clay mineral in hydrogel material. OXI-loaded new hydrogels showed high antifungal activity against Trichophyton mentagrophytes and Trichophyton rubrum dermatophytes. This study suggests that new antifungal thermosensitive CHT/CMC/SGL/MMT nanocomposite hydrogels could be promising materials for onychomycosis treatment.
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Patients whose treatment failures were never frees of diseases and infections for decades. Onychomycosis, from a medical point of view, is considered a cosmetic problem that does not require treatment; however, onychomycosis is an important cause of medical appointments, work absenteeism and often produces a decrease in quality of life of those who suffer [8]. Furthermore self-pollution to other parts of the body is a known risk [9].
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^☆: Supported in part by an educational grant from Janssen Pharmaceutica, Inc.

^☆☆: Reprint requests: Lynn A. Drake, MD, Massachusetts General Hospital, Dermatology - BAR 604, 40 Blossom St., Boston, MA 02114-2696.

^★: 0190-9622/98/$5.00 + 0 16/1/89600

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Effect of onychomycosis on quality of life☆,☆☆,★

Abstract

Section snippets

PATIENTS AND METHODS

RESULTS

DISCUSSION

J Am Acad Dermatol

J Am Acad Dermatol

Onychomycosis is more than a cosmetic problem

Br J Dermatol

Open randomized comparison of itraconazole versus terbinafine in onychomycosis

Int J Dermatol