Quality of life for patients with onychomycosis

Health-related quality of life in patients with nail disorders

Fingernails and toenails are important organs of our body, serving as protection for the tips of fingers and toes. Fingernails also enhance fine touching and tactile sensitivity, as well as aid in the picking up of small objects. Healthy-looking nails are an important part of an individual's body image, and any nail abnormalities may be considered by patients as a significant cosmetic problem, markedly influencing their self-esteem. However, recent data have indicated that nail lesions are not only important because of cosmetic disfigurement, but may be a symptom of significant morbidity. Severe nail involvement was also shown to negatively impair social functioning and to interfere with work ability, thus markedly influencing a patient's well-being. Based on literature data and our own experience we conclude that nail diseases cause a marked decrease in health-related quality of life in a substantial percentage of patients. Nail changes are an important medical concern for patients and, therefore, nail diseases should raise attention and receive proper care from both physicians and other healthcare providers.

Transungual delivery of terbinafine by iontophoresis in onychomycotic nails

Trans-nail permeability is limited due to the innate nature of the nail plate and the recent investigations indicated the potential of iontophoresis in enhancing the transungual drug delivery in normal nails. However, the onychomycotic nails differ from the normal nails with respect to the anatomical and biological features. The current study investigated the effect of iontophoresis (0.5 mA/cm(2) for 1 h) on the transungual delivery of terbinafine in onychomycotic finger and toe nails. The presence of fungi in the onychomycotic nails was diagnosed by potassium hydroxide (KOH) microscopy. Passive and iontophoretic delivery of terbinafine across the infected nail was studied in Franz diffusion cell. Further, the release profile of terbinafine from the drug-loaded nails was investigated by agar diffusion method. KOH microscopy confirmed the presence of fungi in all the nails used. The amount of drug permeated across the nail plate was enhanced significantly during iontophoresis over passive delivery, that is, by 21-fold in case of finger and 37-fold in case of toe nails. Further, the total drug load in the onychomycotic nail was enhanced by ~12-fold (in both finger and toe nails) due to iontophoresis. Release of terbinafine from the iontophoresis-loaded nails into agar plates exhibited two phases, a rapid phase followed by a steady release, which extended >2 months. This study concluded that the drug delivery in onychomycotic nails did not differ significantly when compared with normal nails, although the extent of drug permeation and drug load differs between finger and toe nails.

Evaluation of quality of life in patients with toenail onychomycosis by Polish version of an international onychomycosis-specific questionnaire

BACKGROUND

Onychomycosis is the most frequent nail disease, which could impair the patient's quality of life.

OBJECTIVE

The present study was undertaken to evaluate the impact of toenail onychomycosis on quality of life among Polish population.

PATIENTS AND METHODS

Three thousand nine-hundred and four (3904: 2269 females and 1635 males) individuals fulfilled an international onychomycosis-specific quality-of-life questionnaire consisting of statements regarding social, emotional and symptoms problems. All patients had toenail onychomycosis confirmed by the positive direct microscopic examination and/or by the positive mycologic culture. Seven hundred and sixty-seven patients simultaneously had fingernail onychomycosis. All patients were divided into subgroups according to sex, age, education level, place of living, type of onychomycosis, number of involved toenails, fingernails involvement, duration of illness and previously used antimycotic therapy.

RESULTS

Most of the patients demonstrated significantly reduced quality of life. The degree of life impairment varied between analysed subgroups. Patients with more advanced toenail onychomycosis and with fingernail involvement were more seriously affected. Both social and emotional impairments were more pronounced in female than in male patients, although there were no differences according to symptoms. Moreover, patients with better educational level and people living in towns or cities were more emotionally and socially affected by onychomycosis, although people living in the country or with poorer education level presented with significantly more severe symptoms.

CONCLUSIONS

Toenail onychomycosis is still a serious medical problem, which can significantly reduce the patient's quality of life.

Onychomycosis: beyond cosmetic distress

Onychomycosis, or fungal infection of the nail, is the most common nail disease affecting children (although to a lesser extent) as well as adults. The distress it provokes is not only of a cosmetic kind; it may impair the quality of life. The different clinical types of onychomycosis should be differentiated from similar-looking nail diseases. As far as therapy is concerned, the appearance of new antifungal drugs in the 1990s makes our job easier, but it does not allow us to cure 100% of the patients. Relapses still exist. The aim of this article is to help dermatologists achieve a tailor-made treatment for their patients. The clinical type, the compulsory mycological investigations, the age of the patient, his medical history (drug intake), as well as the use of nail cosmetics, must be considered.

Quality of life instrument for Turkish people with skin diseases

BACKGROUND AND OBJECTIVE

To develop a new, short, self-administrated subjective quality of life (QOL) instrument for Turkish people with skin diseases.

PATIENTS AND METHODS

The 11-item questionnaire of QOL instrument was developed from 200 consecutive dermatological patients' replies. The reliability and validity of the instrument was tested on data gathered from 278 patients with skin diseases attending a dermatology outpatient department and 49 normal subjects. Construct validity was assessed by an exploratory factor analyses and comparisons between patients rated severe and not severe, as well as between normal and patient groups. Reliability was assessed from the internal consistency of the scales and the correlations were made between scores from a 7-10-day retest by using intraclass correlation coefficient.

RESULTS

Factor analyses found six separate dimensions of QOL involving skin disease: social life, emotional life, daily activity, symptoms, cognitive life and sexual life. In addition, 81.3% of common variance was explained by the above factors, all of which correlated with the scale scores of the instrument. The instrument scales were internally consistent (Cronbach's alpha= 0.77-0.84) and scale scores were reproducible after 7-10 days (ICC = 0.63-0.88). Significantly, correlations between scale scores and physician's assessment of the severity of the skin disease were found. Significant differences between diagnostic groups were observed with higher scores for patients with psoriasis, urticaria and acne than those with eczema in the emotional life domain (P < 0.05). In the sexual life domain, however, the eczema group had higher scores than patients with psoriasis, urticaria or acne (P < 0.01).

CONCLUSION

The instrument provides valid and reliable assessments of QOL in Turkish patients with skin disease.

A psychometric study of patients with nail dystrophies

BACKGROUND

Survey studies suggest that patients with various dermatologic conditions experience concomitant psychologic distress.

OBJECTIVE

The purpose of this study was to determine which types of psychologic distress may be correlated with dystrophic disease of the nail in nonpsychiatric patients.

METHODS

Fifty-seven adult subjects presenting for treatment of nail dystrophies completed a survey instrument, which included 5 psychometric measures.

RESULTS

On average, patients rated the severity of their nail dystrophy and functional deficit higher (7.40/10 and 6.00, respectively) than investigators (6.15 and 3.75, respectively). Compared with age- and sex-matched nonpsychiatric patients, subjects in the study were moderately more anxious and minimally to mildly more depressed. Subjects had moderately depressed total self-concept, but their body image was approximately normal. Overall, subjects exhibited markedly more severe psychologic symptoms (84th percentile) than the normal sample, with the scores on the psychoticism, obsessive-compulsive, and paranoid ideation subscales being the most elevated.

CONCLUSION

The subjects with nail dystrophy had markedly exacerbated psychologic symptoms compared with age- and sex-matched nonpsychiatric patients.