Effect of onychomycosis and treatment on patient-reported quality-of-life outcomes: A systematic review

Stewart, Claire; Algu, Leah; Kamran, Rakhshan; Leveille, Cameron F.; Abid, Khizar; Rae, Charlene; Lipner, Shari R.

doi:10.1016/j.jaad.2020.05.143

Cited by 27 publications

(20 citation statements)

References 49 publications

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“…In our study, male patients in either age group felt less stigmatized throughout the study than female ones. It appears that women were more embarrassed about their diseased nails than men, regardless of disease outcome, which is in accordance with the literature [6,7,[9][10][11][12][13]16]. Furthermore, younger patients are more stigmatized by onychomycosis than older patients of the same gender throughout treatment (Tables 1, 2; Fig.…”

Section: Discussionsupporting

confidence: 87%

“…Lubeck et al reported that onychomycosis could have considerable impact on general and mental health, physical appearance, social functioning, and self-confidence [5]. Onychomycosis can lead to restricted social interactions due to embarrassment and low self-esteem [3,[5][6][7][8]. The symptoms of onychomycosis and its effect on the appearance of nails are imperative factors of patients' perception of their health [2].…”

Section: Introductionmentioning

confidence: 99%

“…The validated onychomycosis-specific QOL questionnaires that asses patient's QOL include: the international onychomycosis-specific questionnaire, OnyCOE-t TM , Dermatology Life Quality Index (DLQI), and NailQOL score [6]. Multiple studies have reported that female patients with onychomycosis have poorer baseline QOL scores than male patients and that successful treatment improves the QOL of all patients [6,7,[9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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More than Nail Deep: The Effect of Efinaconazole 10% Treatment on the Quality of Life in Patients with Onychomycosis: A post hoc Study

Gupta

Venkataraman

Quinlan

et al. 2021

Skin Appendage Disord

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Introduction: Onychomycosis is a common, difficult-to-treat fungal nail infection. Clinical signs include nail discoloration and thickening, which patients often find embarrassing, causing a negative impact on their quality of life (QOL). Methods: In this post hoc study, we analyze the effect of efinaconazole 10% solution on a patient’s QOL using patient-reported scores from the OnyCOE-t™ questionnaire (appearance, stigma, physical problems, symptom frequency, symptom bothersomeness, treatment satisfaction, and overall problem). Higher scores corresponded to better functioning, thus higher QOL. Results: Efinaconazole 10% treatment and clinical efficacy were positively correlated with improved QOL in all domains for all groups, except with symptom bothersomeness (how much the onychomycosis symptoms worried or concerned the patient) for female patients <40 years. While still showing improvement in most domains during efficacious treatment, female and younger patients reported lower QOL scores than their male and older counterparts, despite having better clinical outcomes at follow-ups. Discussion: Female and younger patients appear to be more emotionally bothered by their symptoms, regardless of treatment success or improvement of their nail’s appearance, suggesting that onychomycosis is more than nail deep and has a greater psychological effect on these patients. Therefore, younger female patients may require more assurance and mental support.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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More than Nail Deep: The Effect of Efinaconazole 10% Treatment on the Quality of Life in Patients with Onychomycosis: A post hoc Study

Gupta

Venkataraman

Quinlan

et al. 2021

Skin Appendage Disord

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“…Onychomycosis is the most common nail pathology in the world [1] mainly affecting people aged over 60 years [2,3] and significantly impacting the quality of life [4]. Despite its great relevance, the therapeutic options available for onychomycosis are limited, have few pharmacological alternatives, and are slow and costly.…”

Section: Introductionmentioning

confidence: 99%

The Success of Topical Treatment of Onychomycosis Seems to Be Influenced by Fungal Features

Vasconcellos-Pontello

Veiga

Gadêlha

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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Aim. To evaluate the topical treatment of onychomycosis using a 10% hydroalcoholic propolis extract (PE) in two aleatorily chosen patients and analyze possible risk factors from hosts including some particularities of the isolated fungi that may justify the outcomes achieved. Materials and Methods. A topical treatment, with PE, was started in two cases of toe onychomycosis due to T. rubrum. The in vitro PE antifungal activity against these isolates was confirmed. Moreover, the ability of the fungi to infect the human nail was evaluated also in an ex vivo study, analyzed by histopathology. Results. Within four months, both patients showed evident improvement, but with different outcomes. The possible host-related risk factors justifying the poorer outcome in patient 1 include a longer duration time of onychomycosis (50 years). Some particularities in the T. rubrum strain isolated from this patient in relation to that found in patient 2 were observed: (1) the hypha morphology suggesting a major adaptation of the fungus to the host; (2) a 16 times greater propolis concentration was required in vitro; and (3) a faster ability to start a growth using the nail as the only nutritional source. Additionally, this isolate was more efficient in producing a biofilm on the nail surface. Conclusions. A partial clinical and complete mycological cure for the two patients was achieved after four months of PE daily use. Despite a complete recovery, a different outcome was observed between both cases. A more persistent onychomycosis, added to greater fungal potential to produce biofilm on the nail, seems to influence greatly the success of a topical treatment with PE.

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“…Dermatophytes, such as Trichophyton rubrum and T interdigitale , are the most common fungal species implicated in onychomycosis. This superficial infection is usually benign, impairing social interactions because of cosmetic impact 2 or causing local pain, but it can also be the origin of severe dermatophytosis 3 and deep infections in patients receiving immunosuppression therapies 4‐7 . Clear guidelines for onychomycosis management have been established in immunocompetent individuals 8 .…”

Section: Introductionmentioning

confidence: 99%

Severe onychomycosis management with oral terbinafine in a kidney transplantation setting: Clinical follow‐up by image analysis

Moreno-Sabater

Ouali

Chasset

et al. 2020

Mycoses

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Background Severe onychomycosis treatment in kidney transplant recipients (KTR) is challenging because of drug interactions and adverse events. Tacrolimus remains the antirejection treatment (ART) of choice in kidney transplantation but tolerance with systemic terbinafine for the management of severe onychomycosis has not been studied. Objective This study illustrates severe onychomycosis management in a kidney transplantation setting and investigates systemic terbinafine tolerance profile in KTR. Patients/Methods We retrospective analysed clinical data of KTR with a confirmed diagnosis of severe onychomycosis. Results We retrieved a total of 29 KTR with severe onychomycosis needing an oral treatment to manage onychomycosis. In 55.1% (16/29) KTR, altered renal biological parameters or lack of guidelines to manage severe onychomycosis were the main reasons to deterring clinicians from prescribing oral treatments. 13 patients received an oral terbinafine treatment (9, 3 and 1 with a tacrolimus, cyclosporine and everolimus‐based ART, respectively). Clinical and biological follow‐up did not reveal severe drug interactions. ART blood levels showed significant variations in 2 patients without clinical consequences in renal graft. Two patients reported mild adverse events but after only one dose of terbinafine. Using an open‐source image analysis program, clinical evolution of onychomycosis could be retrospectively quantified and followed up. Conclusions The results presented here suggest that oral terbinafine can be proposed to treat severe onychomycosis with an acceptable tolerance profile in KTR with different ART such as tacrolimus and highlight the need of multicentric studies to establish guidelines for onychomycosis treatment in KTR.

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Effect of onychomycosis and treatment on patient-reported quality-of-life outcomes: A systematic review

Cited by 27 publications

References 49 publications

More than Nail Deep: The Effect of Efinaconazole 10% Treatment on the Quality of Life in Patients with Onychomycosis: A post hoc Study

More than Nail Deep: The Effect of Efinaconazole 10% Treatment on the Quality of Life in Patients with Onychomycosis: A post hoc Study

The Success of Topical Treatment of Onychomycosis Seems to Be Influenced by Fungal Features

Severe onychomycosis management with oral terbinafine in a kidney transplantation setting: Clinical follow‐up by image analysis

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