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Trivedi M, Mehta RD, Ghiya BC, Soni P. Impact of Chemotherapy-Induced Nail Changes on Quality of Life: A Cross-Sectional Study from a Tertiary Care Centre. Indian J Dermatol 2024; 69:205-211. [PMID: 39119313 PMCID: PMC11305505 DOI: 10.4103/ijd.ijd_723_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
Background Chemotherapy has increased survival rate in patients but is associated with systemic as well as cutaneous adverse effects. Among cutaneous adverse effects, nail changes caused by chemotherapy are often overlooked. But these changes are a major cause of cosmetic concern and negatively affect the quality of life (QoL) of patients. Aim This study was conducted to evaluate the impact of chemotherapy-induced nail changes on QoL of patients with malignancy and to compare the severity of impact on QoL in various nail changes. Materials and Methods This hospital-based cross-sectional observational study was conducted for a period of 12 months. Only patients on chemotherapy who developed nail changes were included in the study. A nail-specific QoL questionnaire was used. Statistical analysis was conducted to evaluate the impact of nail changes on QoL. Results The mean QoL score of 188 patients was 32.37 ± 7.9. The mean QoL score of females was more than that of males. QoL was statistically more significant in younger age groups [<20 years: 46.71 ± 1.7] (P < 0.001). Patients with pigmentary nail changes (melanonychia and leukonychia) had more significant impact on QoL (P < 0.001). Conclusion There is a significant impact of chemotherapy-induced nail changes on QoL of patients leading to psychological distress, reduced self-confidence and social limitation. This highlights the importance of proper counselling of patients beforehand regarding the possibility of associated nail changes during and after the chemotherapy regimens.
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Affiliation(s)
- Madhvi Trivedi
- From the Department of Dermatology Venereology and Leprosy, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Rajesh D. Mehta
- From the Department of Dermatology Venereology and Leprosy, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - B. C. Ghiya
- From the Department of Dermatology Venereology and Leprosy, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Prasoon Soni
- From the Department of Dermatology Venereology and Leprosy, Sardar Patel Medical College, Bikaner, Rajasthan, India
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Klassen AF, Rae C, O’Malley M, Breitkopf T, Algu L, Mansouri J, Brown CR, Wang Y, Lipner SR. Development and Validation of a Patient-Reported Outcome Measure for Fingernail and Toenail Conditions: The NAIL-Q. Clin Cosmet Investig Dermatol 2023; 16:3091-3105. [PMID: 37915422 PMCID: PMC10617399 DOI: 10.2147/ccid.s429120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/07/2023] [Indexed: 11/03/2023]
Abstract
Background Patient-reported outcome measures (PROMs) are needed to measure outcomes that matter to people with nail conditions, from their perspective. Objective To design a comprehensive new PROM (NAIL-Q) to measure outcomes important in toenail and fingernail conditions. Methods A mixed methods iterative approach was used. Phase 1 involved concept elicitation interviews that were audio-recorded, transcribed, and coded line-by-line. Concepts were developed into scales and refined through cognitive debriefing interviews with patients and expert input. Data was then collected from an international sample using a crowdsource platform. Eligible participants were aged ≥18 years with a nail condition for at least 3 months. Rasch Measurement Theory (RMT) analysis was used to examine item and scale performance. Other psychometric tests included test-retest reliability, and convergent and construct validity. Results Phase 1 interviews involved 23 patients with 10 nail conditions and input from 11 dermatologists. The analysis led to the development of 84 items for field-testing. In Phase 2, 555 participants completed the survey. Toenail conditions (n = 441) were more common than fingernail conditions (n = 186). The RMT analysis reduced the number of items tested to 45 in 7 scales measuring nail appearance, health-related quality of life concerns, and treatment outcomes. All items had ordered thresholds and nonsignificant chi-square p values. Reliability statistics with and without extremes for the Person Separation Index were ≥0.79 and Cronbach's alpha were ≥0.83, and for intraclass correlation coefficients were ≥0.81. Construct validity was further supported in that most participants agreed that the NAIL-Q was easy to understand, asked relevant and important questions in a respectful way, and that it should be used to inform clinical care. Conclusion The NAIL-Q is a rigorously designed and tested PROM that measures nail appearance, health-related quality of life and treatment outcomes. This PROM can be used in clinical practice to inform patient care and to include the patient perspective in research.
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Affiliation(s)
- Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Maureen O’Malley
- Division of Dermatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Trisia Breitkopf
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Leah Algu
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Jasmine Mansouri
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Claire R Brown
- Department of Dermatology, Weill Cornell Medicine, New York City, NY, USA
| | - Yi Wang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York City, NY, USA
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Kovalyova JS, Kokina OA, Vedler AA, Karkhova VV, Makarenko ES, Pisarev VV, Merkulov ME. The results of open-label, randomized, actively-controlled study of the efficacy, safety and tolerability of the novel combined product (terbinafine hydrochloride + econazole nitrate), medicinal nail polish for local monotherapy of onychomycosis. VESTNIK DERMATOLOGII I VENEROLOGII 2022. [DOI: 10.25208/vdv1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background. Currently, onychomycosis is an urgent and widespread problem in dermatology. The defeat of the nail plates is the cause of a cosmetic defect and a decrease in the quality of life of patients. Systemic antimycotics are effective, but have a number of side effects when used. Thus, a modern and effective approach to the treatment of patients with this pathology is needed.
The aim of the study. To prove the efficacy, safety and tolerability of Ekzilak as local monotherapy of onychomycosis compared with cyclopyrox monotherapy.
Materials and methods. А randomized open-label study with active control included 172 outpatient subjects: men and women aged 18 to 75 years, with microscopically confirmed onychomycosis of the big toe (one or both feet), a superficial or distal form of onychomycosis with a lesion of no more than 1/3 of the nail length (KIOTOS from 1 to 6). Patients were randomized into two groups: the 1st group of patients applied Ekzilak locally daily for 6 months, the 2nd group of patients applied Ciclopirox nail lacquer topical solution 8% as follows: 1 time a day for the first month, 2 times a week for the second one and 1 time a week for the months third-sixth. The preparations were applied in a thin layer to the affected nail. The primary efficacy endpoint in the study was the proportion of patients who achieved complete recovery of the target toenail at the end of therapy (clinical + mycological recovery). Secondary endpoints included the proportion of patients who achieved clinical recovery after 6 months of treatment (clinical recovery is a complete restoration of the normal morphology of the affected nail), the proportion of patients who achieved mycological recovery (microscopy with KOH solution) after 3 months of treatment, the proportion of patients who achieved complete recovery of the target toenail in 4 weeks after the end of treatment; IGA (Investigator's Global Assessment), Integrated Medicine Patient Satisfaction Scale (IMPSS); the safety Analysis was carried out throughout the study and included an assessment of adverse events, laboratory data, vital signs.
Results. The results of the study showed that Ekzilak is superior in terms of efficacy to the registered drug Ciclopirox nail lacquer topical solution 8% as a local monotherapy of onychomycosis. The difference in the proportion of patients who achieved complete recovery between the study drug and the reference drug was 22.09%, 95% CI for the difference in the proportion was [8.21%; 35.97%], the differences between the groups are statistically significant (p=0.002). At the same time, the analysis of safety data, including the assessment of adverse events, laboratory studies and impact on vital signs, did not reveal statistically and clinically significant differences between the treatment groups.
Conclusions. New combination drug Ekzilak is an effective and safe treatment option for patients with onychomycosis.
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Ortner VK, Nguyen N, Brewer JR, Solovyeva V, Haedersdal M, Philipsen PA. Fractional CO 2 laser ablation leads to enhanced permeation of a fluorescent dye in healthy and mycotic nails-An imaging investigation of laser-tissue effects and their impact on ungual drug delivery. Lasers Surg Med 2022; 54:861-874. [PMID: 35451510 PMCID: PMC9544547 DOI: 10.1002/lsm.23541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 01/10/2022] [Accepted: 03/14/2022] [Indexed: 12/03/2022]
Abstract
Purpose Conventional oral antifungal therapies for onychomycosis (OM) often do not achieve complete cure and may be associated with adverse effects, medical interactions, and compliance issues restricting their use in a large group of patients. Topical treatment can bypass the systemic side effects but is limited by the physical barrier of the nail plate. Ablative fractional laser (AFL) treatment can be used to improve the penetration of topical drugs into the nail. This study visualized the effects of laser ablation of nail tissue and assessed their impact on the biodistribution of a fluorescent dye in healthy and fungal nail tissue. Methods For the qualitative assessment of CO2 AFL effects on healthy nail tissue, scanning electron microscopy (SEM), coherent anti‐Stokes Raman scattering microscopy (CARS‐M), and widefield fluorescence microscopy (WFM) were used. To quantitate the effect of laser‐pretreatment on the delivery of a fluorescent dye, ATTO‐647N, into healthy and fungal nail tissue, ablation depth, nail plate thickness, and ATTO‐647N fluorescence intensity in three nail plate layers were measured using WFM. A total of 30 nail clippings (healthy n = 18, fungal n = 12) were collected. An aqueous ATTO‐647N solution was directly applied to the dorsal surface of 24 nail samples (healthy n = 12, fungal n = 12) and incubated for 4 hours, of which half (healthy n = 6, fungal n = 6) had been pretreated with AFL (30 mJ/mb, 15% density, 300 Hz, pulse duration <1 ms). Results Imaging revealed a three‐layered nail structure, an AFL‐induced porous ablation crater, and changes in autofluorescence. While intact fungal samples showed a 106% higher ATTO‐647N signal intensity than healthy controls, microporation led to a significantly increased fluorophore permeation in all samples (p < 0.0001). AFL processing of nail tissue enhanced topical delivery of ATTO‐647N in all layers, (average increase: healthy +108%, fungal +33%), most pronounced in the top nail layer (healthy +122%, fungal +68%). While proportionally deeper ablation craters correlated moderately with higher fluorescence intensities in healthy nail tissue, fungal samples showed no significant relationship. Conclusion Fractional CO2 laser microporation is a simple way of enhancing the passive delivery of topically applied ATTO‐647N. Although the impaired nail plate barrier in OM leads to greater diffusion of the aqueous solution, AFL can increase the permeability of both structurally deficient and intact nails.
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Affiliation(s)
- Vinzent Kevin Ortner
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Nhi Nguyen
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Jonathan R Brewer
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Vita Solovyeva
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark.,Faculty of Mathematics and Science, University of Oldenburg, Oldenburg, Germany
| | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Peter Alshede Philipsen
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Patient-reported outcome measures for patients with nail conditions: a systematic review of the psychometric evidence. Arch Dermatol Res 2021; 314:223-237. [PMID: 33818656 DOI: 10.1007/s00403-021-02222-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/18/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
Nail conditions have an impact on appearance, function, and quality of life of patients. Patient reported outcome measures (PROMs) are important tools for evaluating treatment success from the patient perspective. It is important to understand the quality of PROMs to help guide selection of appropriate tools. The aim of this study was to critically appraise the psychometric properties of nail-specific PROMs using COSMIN guidelines. A systematic review was conducted in May 2019 to identify development and validation articles for nail-specific PROMs. Abstracts and subsequent full-texts were screened by two reviewers for eligibility. Data were extracted for study characteristics and psychometric properties. The risk of bias checklist was completed, and ratings applied to psychometric properties as per COSMIN guidelines. Modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria were applied based on the risk of bias checklist to assess methodological quality. The review identified 3289 articles of which 430 full-text articles were screened, nine of which met eligibility criteria. Included papers were for seven PROMs and in total reported on 31of 49 possible measurement properties. Of the 31 measurement properties reported, nine (29%) were rated as insufficient or indeterminate. The modified GRADE methodological quality rating was low or very low for 16 (32.7%) measurement properties, and 18 (36.7%) measurement properties were not described by any PROM. Currently there are no nail-specific PROMS available that demonstrate adequate validity, reliability, or responsiveness, according to COSMIN guidelines. Further research is required to assess missing or insufficiently tested measurement properties in all the PROMs identified.
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6
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Ortner VK, Franco W, Haedersdal M, Philipsen PA. Noninvasive Assessment of Mycotic Nail Tissue Using an Ultraviolet Fluorescence Excitation Imaging System. Lasers Surg Med 2020; 53:245-251. [PMID: 32538499 DOI: 10.1002/lsm.23285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/16/2020] [Accepted: 05/30/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Mycological diagnosis of onychomycosis is based on direct microscopy using external fluorophores to visualize fungal tissue in nail samples and agar culture. Ultraviolet fluorescence excitation imaging (u-FEI) has shown potential in monitoring biological processes by exploiting variations in autofluorescence. This study aimed at assessing the potential of a handheld u-FEI system as a practical screening tool for fungal nail infections. STUDY DESIGN/MATERIALS AND METHODS Ninety samples from 29 patients with microscopy-confirmed fungal infection and 10 control samples from healthy participants were collected (n = 100). Using a prototype u-FEI system (single bandpass 25 mm filter with a central pass wavelength of 340 nm and a bandwidth of 12 nm, 295 nm excitation flash, resolution of 640 × 480), images of all samples were acquired under standardized conditions. Average and maximum fluorescence intensity image values in arbitrary units (AU) of manually delineated regions of interests were quantitated and statistically assessed for significant differences between healthy and mycotic samples. RESULTS UV-images clearly depicted all 100 nail samples, with a visibly stronger signal in infected samples. Statistically significant differences (P < 0.05) in signal intensity between mycotic samples and healthy controls were observed for maximum and average fluorescence values. Mean fluorescence values of onychomycotic samples showed 23.9% higher maximum (mycotic: 34.9 AU [standard deviation [SD] 4.7]; healthy: 28.2 AU [SD 1.9]) and 10.2% higher average (mycotic: 27.6 AU [SD 2.0]; healthy: 25.0 AU [SD 0.7]) signal intensity values. Receiver operating characteristic curves demonstrated excellent discriminatory ability (area under the curve > 0.9). Analysis of fluorescence measurements of the reference standard demonstrated very low variation (coefficient of variation = 0.62%) CONCLUSION: Quantitation of u-FEI intensities enables differentiation between healthy and mycotic nail samples, constituting a potential point-of-care tool for cost-effective screening for onychomycosis at a primary care level. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Vinzent Kevin Ortner
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen NV, 2400, Denmark
| | - Walfre Franco
- Department of Dermatology, Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom St, Thier 209, Boston, Massachusetts, 02114
| | - Merete Haedersdal
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen NV, 2400, Denmark.,Department of Dermatology, Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom St, Thier 209, Boston, Massachusetts, 02114
| | - Peter Alshede Philipsen
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen NV, 2400, Denmark
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7
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Stewart CR, Algu L, Kamran R, Leveille CF, Abid K, Rae C, Lipner SR. Effect of onychomycosis and treatment on patient-reported quality-of-life outcomes: A systematic review. J Am Acad Dermatol 2020; 85:1227-1239. [PMID: 32502586 DOI: 10.1016/j.jaad.2020.05.143] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/12/2020] [Accepted: 05/29/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND 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. OBJECTIVE The objectives of this study were to systematically review the available literature describing the effect of onychomycosis and treatment on quality of life. METHODS 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. RESULTS 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. CONCLUSIONS 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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Affiliation(s)
| | - Leah Algu
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rakhshan Kamran
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Cameron F Leveille
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Khizar Abid
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York.
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Tabassum H, Adil M, Amin SS, Mohtashim M, Bansal R, Agrawal D. The Impact of Onychopathies on Quality of Life: A Hospital-based, Cross-sectional Study. Indian Dermatol Online J 2020; 11:187-194. [PMID: 32477977 PMCID: PMC7247629 DOI: 10.4103/idoj.idoj_272_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Onychopathies or nail disorders are associated with social stigma and causes limitation of daily activities by hampering the function of both fingers and toes. Aim: To evaluate the impact of onychopathies on quality of life (QoL) and compare the severity of impact on QoL in various nail disorders. Materials and Methods: A hospital-based cross-sectional study consisting of 540 patients with onychopathies was conducted in the dermatology outpatient department. Patients were requested to complete a nail-specific QoL questionnaire consisting of 24 and 16 questions, respectively, for fingernails (group F) and toenails (group T) with five possible responses to each question. A score of 1-5 was given to each response. Statistical analysis was done to compare the impact of QoL on the different types of onychopathies. Results: We found that onychopathies have a significant impact on QoL. QoL was significantly more affected when multiple nails were involved (P = 0.020 for group F and P = 0.001 for group T). QoL impact was statistically more significant in women (P = 0.038 for group F and P < 0.001 for group T) and in younger people aged <20 years in group F and 20-39 years in group T (P < 0.001 for both groups F and T). Patients with onychomycosis, structural nail defects, and psoriasis had a more significant impact than other diseases (P < 0.001 for both groups F and T). Conclusion: Onychopathies have a significant adverse effect on QoL because of their serious physical, psychological and social impact. Hence, clinicians should treat the nail disorders with utmost seriousness.
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Affiliation(s)
- Hera Tabassum
- Department of Dermatology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mohammad Adil
- Department of Dermatology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Syed S Amin
- Department of Dermatology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mohd Mohtashim
- Department of Dermatology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Roopal Bansal
- Department of Dermatology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Divya Agrawal
- Department of Dermatology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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9
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Kayarkatte MN, Singal A, Pandhi D. Impact of Onychomycosis on the Quality of Life: Dermatology Life Quality Index-Based Cross-Sectional Study. Skin Appendage Disord 2020; 6:115-119. [PMID: 32258055 DOI: 10.1159/000504944] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 11/20/2019] [Indexed: 11/19/2022] Open
Abstract
Background Onychomycosis (OM) is a common fungal infection of the nail unit with a worldwide prevalence of 5%. Though apparently a benign and innocuous entity, it carries significant psychosocial morbidity. The Dermatology Life Quality Index (DLQI) is based on a simple practical questionnaire that considers multiple psychological and social domains. Its utility in OM by far remains unexplored. Objective To determine the DLQI in patients suffering from OM. Methods The DLQI questionnaire was answered by 100 patients with an established diagnosis of OM. Results The mean DLQI of our study subjects was 6.1 ± 3.3. Most patients (46%) belonged to the DLQI 2 group (moderate effect). Among these, most patients reported disease duration of 1-5 years (50%). Among patients responding to DLQI 3 (very large effect), a higher significant proportion were females (66.7%). The most inconvenient domain was seeking treatment for OM and social embarrassment due to the disease. Conclusion As DLQI is an easy scoring method, it can be used for assessing quality of health in OM. OM causes moderate effect on quality of life (mostly DLQI 2), thereby making its treatment mandatory.
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Affiliation(s)
- Manasa Narayan Kayarkatte
- Department of Dermatology, Leprosy, and STD, University College of Medical Sciences and GTB Hospital, University of Delhi, Delhi, India
| | - Archana Singal
- Department of Dermatology, Leprosy, and STD, University College of Medical Sciences and GTB Hospital, University of Delhi, Delhi, India
| | - Deepika Pandhi
- Department of Dermatology, Leprosy, and STD, University College of Medical Sciences and GTB Hospital, University of Delhi, Delhi, India
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10
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Galvão EL, Pedras MJ, Cota GF, Simões TC, Rabello A. Development and initial validation of a cutaneous leishmaniasis impact questionnaire. PLoS One 2018; 13:e0203378. [PMID: 30161222 PMCID: PMC6117079 DOI: 10.1371/journal.pone.0203378] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 08/20/2018] [Indexed: 12/26/2022] Open
Abstract
Background The impact of cutaneous leishmaniasis (CL) on the quality of life of patients has been neglected in research studies worldwide. The few reported studies have used non-specific questionnaires for the disease, which represents a limitation since generic instruments may not address specific aspects of the disease, compromising the evaluation of its real impact. The aim of this paper is to describe the development and the initial validation of an instrument for evaluating the impact of CL, named the Cutaneous Leishmaniasis Impact Questionnaire. Methodology The formulation and validation of the instrument consisted of the following steps: (1) literature review; (2) conceptual framework construction and initial item generation; (3) tool analysis by health professionals (experts); (4) tool evaluation performed by the patients; and (5) a pilot study with 100 patients with localized CL, evaluated at a reference ambulatory facility in Belo Horizonte, in the state of Minas Gerais, Brazil. The structure of the proposed instrument was analyzed using hierarchical cluster analysis (ICLUST). Results Twenty-seven items were initially proposed by the researchers to compose the questionnaire. Content validity (evaluates if the instrument fully assesses the construct of interest) was evaluated by the panel of experts, while face validity (evaluates how potential participants interpret the items) was evaluated by the target population. In this step, some items were excluded, reformulated and/or included. After evaluating a factorial structure of the items in accordance with the cluster analysis, we assembled a questionnaire with 25 items (alpha = 0.86), with high reliability and homogeneity, which address the following: 1) the general impact of the disease (alpha = 0.91, beta = 0.67) and 2) the evaluation of the perception about the treatment and health services (alpha = 0.72, beta = 0.51). Conclusions The Cutaneous Leishmaniasis Impact Questionnaire, developed with contributions from patients and experts, was confirmed, in this first validation, as a useful and reliable instrument.
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Affiliation(s)
- Endi Lanza Galvão
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias–Instituto René Rachou—Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
| | - Mariana Junqueira Pedras
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias–Instituto René Rachou—Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| | - Gláucia Fernandes Cota
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias–Instituto René Rachou—Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| | - Taynãna César Simões
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias–Instituto René Rachou—Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Rabello
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias–Instituto René Rachou—Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
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11
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Gupta AK, Versteeg SG, Shear NH. A practical application of onychomycosis cure - combining patient, physician and regulatory body perspectives. J Eur Acad Dermatol Venereol 2018; 33:281-287. [PMID: 30005134 DOI: 10.1111/jdv.15181] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 07/10/2018] [Indexed: 11/28/2022]
Abstract
Due to the high relapse rates and the rise of predisposing factors, the need for curing onychomycosis is paramount. To effectively address onychomycosis, the definition of cure used in a clinical setting should be agreed upon and applied homogeneously across therapies (e.g. oral, topical and laser treatments). In order to determine what is or what should be used to define cure in a clinical setting, a literature search was conducted to identify methods used to evaluate treatment success. The limitations, strengths, prevalence and utility of each outcome measure were investigated. Seven ways to measure treatment success were identified; mycological cure, patient/investigator assessments, complete cure, quality of life instruments, severity indexes, clinical cure and temporary clearance. Despite its shortcomings, mycological cure is the most objective and consistent outcome measure used across onychomycosis studies. It is suggested that diagnostic goals of onychomycosis should be used to define cure in a clinical setting. Modifications to outcome measures such as incorporating molecular-based techniques could be a future avenue to explore.
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Affiliation(s)
- A K Gupta
- Divison of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, ON, Canada.,Mediprobe Research Inc., London, ON, Canada
| | | | - N H Shear
- Department of Medicine (Dermatology, Clinical Pharmacology and Toxicology), Department of Pharmacology, Sunnybrook Health Science Centre and the University of Toronto, Toronto, ON, Canada
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Daily Application of an Aqueous, Acidifying, Peelable Nail Polish versus Weekly Amorolfine for Topical Onychomycosis Treatment: A Prospective, Randomized, Blinded Trial. Dermatol Ther (Heidelb) 2018; 8:463-473. [PMID: 30051298 PMCID: PMC6109032 DOI: 10.1007/s13555-018-0254-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction Onychomycosis is a fungal nail infection, frequently caused by dermatophytes, which occurs in 2–14% of Western adults. The present study was set up to evaluate the efficacy and safety of a water-based, peelable nail polish (daily application), which acidifies the nail environment, versus a 5% amorolfine nail lacquer (weekly application) for topical treatment of mild-to-moderate onychomycosis. Methods One hundred two adults were randomized in this open, prospective, blinded trial. Clinical efficacy was evaluated at baseline and days 30, 60, 120, and 180, respectively. All patients underwent microbiological testing (at baseline and study end). The primary objective of this trial was the change in the percentage of healthy nail surface at day 180. Results The percentage of healthy surface between baseline and day 180 increased with 11.8% in the test product group and 13.2% in the amorolfine group, which were statistically comparable. Other onychomycosis-related parameters (dystrophy, discolouration, thickening, and healthy aspect, respectively) showed significant (p < 0.05) improvement after 180 days (versus baseline) with both treatments. Clinical performance was further confirmed by the frequency of patients showing onychomycosis improvement or success at the end of the study: 96.0% (test product) versus 79.6% (amorolfine). Microbiological results and improved quality of life confirmed clinical performance. Both treatments were well tolerated and appreciated for their properties and efficacy. Conclusion The present trial confirmed the clinical performance of daily acidification of the nail, as reflected by (1) a comparable increase of percentage of healthy nail surface following treatment with the test product versus amorolfine, (2) the overall improvement of other onychomycosis-related parameters, (3) user convenience, and (4) absence of side effects. These data indicate that daily application of an aqueous, acetic acid-based, peelable solution can be a convenient, safe, and equally effective alternative for the topical management of onychomycosis. Trial Registration ClinicalTrials.gov identifier; NCT03382717 Funding Oystershell Laboratories.
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13
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Gupta AK, Mays RR. The Impact of Onychomycosis on Quality of Life: A Systematic Review of the Available Literature. Skin Appendage Disord 2018; 4:208-216. [PMID: 30410887 DOI: 10.1159/000485632] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 11/23/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose Onychomycosis is a nail disorder that is increasing in prevalence worldwide. The psychological and social limitations caused by onychomycosis can potentially undermine the work and social lives of those experiencing these negative effects. This review aimed to evaluate the randomized controlled trials (RCTs) available in the current literature on the impact onychomycosis has on quality of life (QoL). Methods A systematic review was performed using the databases PubMed, PsycINFO, Scopus, ClinicalTrials.gov, and Cochrane Library on July 18, 2017. Only RCTs with clinical effects described in English were included for review. Results Ten RCTs reported QoL outcomes for patients suffering from onychomycosis. Treatment satisfaction was statistically significant from baseline to end of treatment in 100.0% (4/4) measures which reported on satisfaction with treatment; mental health was also significant in 100.0% (3/3), symptoms index rating in 100.0% (2/2), symptom frequency in 75.0% (3/4), overall problems in 75.0% (3/4), functional activities in 75.0% (6/8), appearance problems in 66.7% (2/3), symptom distress in 57.1% (4/7), and stigma in 40.0% (2/5). The OnyCOE-tTM and the NailQoL were the most used common outcome measures to describe QoL. Conclusion The study sanctions that onychomycosis physically and psychologically distresses patients' lives. Further research should include validated outcome measures to more effectively treat onychomycosis.
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Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Inc., London, Ontario, Canada.,Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
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14
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Yamaguchi H. Potential of Ravuconazole and its Prodrugs as the New OralTherapeutics for Onychomycosis. Med Mycol J 2017; 57:E93-E110. [PMID: 27904057 DOI: 10.3314/mmj.16-00006] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Onychomycosis is a fungal infection of the nail apparatus caused by dermatophytes, Candida and non-dermatophytic molds. It is highly prevalent in the general population worldwide and also responsible for significant morbidity and complications and does not usually cure itself. Thus, the condition needs to be treated in view of physical and psychological problems produced. Currently, oral medications using terbinafine are the most effective therapy, but it has relatively limited therapeutic success, particularly for long-term management. Such existing oral therapies are associated with high recurrence rates and treatment failure, as well as with potential adverse events and drug-drug interactions. In the light of these issues, development of more efficacious and safer alternatives for the treatment of onychomycosis is warranted.Ravuconazole and its prodrugs are promising new drug candidates for oral therapy of onychomycosis, among which a water-soluble prodrug, mono-lysine phosphoester derivative (E1224 or BFE1224) is in the most advanced stage of clinical development; a Phase II dose-finding study has been successfully completed and Phase III comparative studies are in progress in Japan.This review aims to summarize our current status of knowledge and information on ravuconazole and its prodrugs, particularly BFE1224, as the potential oral treatment option for onychomycosis. It also summarize the clinical features of onychomycosis with particular stress on its etiology, epidemiology, and current therapeutic options and their limitations. Given its clinical usefulness, BFE1224 may become a valuable addition to the current armamentarium for the treatment of onychomycosis.
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Gupta AK, Versteeg SG, Shear NH. Onychomycosis in the 21st Century: An Update on Diagnosis, Epidemiology, and Treatment. J Cutan Med Surg 2017. [PMID: 28639462 DOI: 10.1177/1203475417716362] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Onychomycosis accounts for 50% of all nail disease cases and is commonly caused by dermatophytes. Diabetes, human immunodeficiency virus, immunosuppression, obesity, smoking, and advancing age are predisposing factors of this fungal infection. Potassium hydroxide and culture are considered the current standard for diagnosing onychomycosis, revealing both fungal viability and species identification. Other diagnostic tests currently available include periodic acid-Schiff staining, polymerase chain reaction techniques, and fluorescent staining. Across 6 recently published epidemiology studies, the global prevalence of onychomycosis was estimated to be 5.5%, falling within the range of previously reported estimates (2%-8%). Newly approved onychomycosis treatments include efinaconazole, tavaborole, and laser therapy with lasers only approved to temporarily increase the amount of clear nail. Additional onychomycosis treatments being investigated include iontophoresis and photodynamic therapy with small open-label studies reported thus far. Preventative strategies, to help decrease recurrence and reinfection rates, include sanitisation of footwear and prophylactic topical antifungal agents.
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Affiliation(s)
- Aditya K Gupta
- 1 Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada.,2 Mediprobe Research, Inc, London, Ontario, Canada
| | | | - Neil H Shear
- 3 Department of Medicine (Dermatology, Clinical Pharmacology and Toxicology) and Department of Pharmacology, Sunnybrook and Women's College Health Science Centre and the University of Toronto, Toronto, Ontario, Canada
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Wang J, Wiznia LE, Rieder EA. Patient-Reported Outcomes in Onychomycosis: A Review of Psychometrically Evaluated Instruments in Assessing Treatment Effectiveness. Skin Appendage Disord 2017; 3:144-155. [PMID: 28879191 DOI: 10.1159/000469666] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/08/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Onychomycosis is the most common nail disorder and causes morbidity and impaired quality of life (QOL). Patient-reported outcomes (PRO) are patients' assessment of their health status or treatment response. PROs help assess what is most bothersome to patients to identify targets for intervention. We sought to review the PRO instruments currently used to assess QOL and treatment response in onychomycosis patients. PROCEDURES A systematic review was performed by searching PubMed, Embase, CINAHL, and PsycINFO databases through December 31, 2016, to identify all English language literature on onychomycosis, PRO, and QOL. RESULTS Currently, 5 validated PRO instruments exist specifically for onychomycosis. Oral therapies were most extensively studied using PRO instruments. QOL data generally correlated with clinical change, although patients sometimes reported improvement without any clinically significant nail clearance. The only psychometrically validated PRO instrument used to evaluate treatment response is the OnyCOE-t™. CONCLUSIONS Clinicians may underestimate the impact of onychomycosis on patients. With recent initiatives from health-care management organizations to improve patient experience and the recent approval of expensive and nonsuperior topical antifungal medications, PROs will be increasingly important in onychomycosis to assess patient priorities and optimize treatment. Future research should evaluate these instruments in special populations and fingernail disease.
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Affiliation(s)
| | - Lauren E Wiznia
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - Evan A Rieder
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
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17
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Halteh P, Scher RK, Lipner SR. Onychophagia: A nail-biting conundrum for physicians. J DERMATOL TREAT 2016; 28:166-172. [DOI: 10.1080/09546634.2016.1200711] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Nijenhuis-Rosien L, Kleefstra N, Wolfhagen MJ, Groenier KH, Bilo HJG, Landman GWD. Laser therapy for onychomycosis in patients with diabetes at risk for foot complications: study protocol for a randomized, double-blind, controlled trial (LASER-1). Trials 2015; 16:108. [PMID: 25872590 PMCID: PMC4381488 DOI: 10.1186/s13063-015-0622-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/27/2015] [Indexed: 11/25/2022] Open
Abstract
Background In a sham-controlled double-blind trial, we aim to establish the efficacy and safety of the local application of laser therapy in patients with diabetes, onychomycosis and risk factors for diabetes-related foot complications. Onychomycosis leads to thickened and distorted nails, which in turn lead to increased local pressure. The combination of onychomycosis and neuropathy or peripheral arterial disease (PAD) increases the risk of developing diabetes-related foot complications. Usual care for high-risk patients with diabetes and onychomycosis is completely symptomatic with frequent shaving and clipping of the nails. No effective curative local therapies exist, and systemic agents are often withheld due to concerns for side effects and interactions. Methods/Design The primary aim is to evaluate the efficacy of four sessions of Nd:YAG 1064 nM laser application on the one-year clinical and microbiological cure rate in a randomized, double-blind, sham-controlled design with blinded outcome assessment. Mandatory inclusion criteria are diagnosis of diabetes, risk factors for developing foot ulcers defined as a modified Simm’s classification score 1 or 2 and either neuropathy or PAD. A total of 64 patients are randomized to intervention or sham treatment performed by a podiatrist. Discussion This study will be the first double-blind study that investigates the effects of local laser therapy on onychomycosis, specifically performed in patients with diabetes with additional risk factors for foot complications. Trial registration Clinical trials.gov as NCT01996995, first received 22 November 2013.
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Affiliation(s)
- Leonie Nijenhuis-Rosien
- Diabetes Centre, Isala, Dr Spanjaardweg 11, 8025 BT, Zwolle, the Netherlands. .,Innofeet Voetencentrum Nijenhuis Podiatry, Simon Stevinweg 13, 8013 NA, Zwolle, the Netherlands.
| | - Nanne Kleefstra
- Diabetes Centre, Isala, Dr Spanjaardweg 11, 8025 BT, Zwolle, the Netherlands. .,Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands. .,Langerhans Medical Research Group, Postbus 21, 4254 ZG, Sleeuwijk, the Netherlands.
| | - Maurice J Wolfhagen
- Department of Medical Microbiology, Isala, Dr. van Heesweg 2, 8025 AB, Zwolle, the Netherlands.
| | - Klaas H Groenier
- Diabetes Centre, Isala, Dr Spanjaardweg 11, 8025 BT, Zwolle, the Netherlands. .,Department of General Practice, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands.
| | - Henk J G Bilo
- Diabetes Centre, Isala, Dr Spanjaardweg 11, 8025 BT, Zwolle, the Netherlands. .,Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands. .,Department of General Practice, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands.
| | - Gijs W D Landman
- Diabetes Centre, Isala, Dr Spanjaardweg 11, 8025 BT, Zwolle, the Netherlands. .,Department of Internal Medicine, Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, the Netherlands.
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Augustin M, Langenbruch AK, Herberger K, Baade K, Goepel L, Blome C. Quality of life measurement in chronic wounds and inflammatory skin diseases: Definitions, standards and instruments. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.wndm.2014.04.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Nanda S, Grover C. Utility of gel nails in improving the appearance of cosmetically disfigured nails: experience with 25 cases. J Cutan Aesthet Surg 2014; 7:26-31. [PMID: 24761096 PMCID: PMC3996786 DOI: 10.4103/0974-2077.129968] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: Gel nails are a commonly used cosmetic procedure, though their use by dermatologists has not been evaluated. These can be used to improve the appearance of cosmetically disfigured nails where other treatment options have failed; the condition is self-limiting or irreversible; or to camouflage the dystrophy until healing. Materials and Methods: A prospective, uncontrolled, open-label study on 25 participants presenting with cosmetically disfigured nails was undertaken. Mycologically negative, consenting patients with various nail plate surface abnormalities like trachyonychia (n =8); superficial pitting (n =6); onychorrhexis (n =4); superficial pitting with onychoschizia (n =3); Beau's lines (n =3) and pterygium (n =1) were included. The patients received gel nail application using Ranara gel nail kit®. Extra care was taken to avoid any damage to cuticle. Standard pre- and post-treatment photographs were taken to assess improvement. Patient satisfaction score (1-10); Global assessment score of improvement (no improvement to excellent improvement) and any side effects reported were recorded. Results: The average age of treated patients was 30.44±11.39 years (range 18-60 years). A total of 69 nails were treated (average of 2.76 per patient). Post-procedure, the average patient satisfaction score was 9.08 ± 0.86 (range 7-10). The Global assessment showed excellent improvement (40% cases); good improvement (56% cases) and mild improvement in the single case of pterygium treated. Conclusions: The use of Gel nails in patients with cosmetically disfiguring nail plate surface abnormalities (like trachyonychia, onychoschizia, pitting, etc.) was found to produce good to excellent improvement in most of the cases. The patient satisfaction with the procedure was rated as high. This, coupled with absence of side effects, make gel nails a valuable tool in improving cosmesis and satisfaction among patients presenting with nail plate surface abnormalities. Further studies with larger number of patients are required to assess the impact these prostheses can have.
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Affiliation(s)
- Soni Nanda
- Consultant Dermatologist, Shine and Smile Clinic, Delhi, India
| | - Chander Grover
- Department of Dermatology, UCMS and GTB Hopsital, Delhi, India
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Luliconazole demonstrates potent in vitro activity against dermatophytes recovered from patients with onychomycosis. Antimicrob Agents Chemother 2014; 58:3553-5. [PMID: 24709260 DOI: 10.1128/aac.02706-13] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The in vitro activities of luliconazole, amorolfine, ciclopirox, and terbinafine were determined against 320 dermatophyte isolates from large toenails of onychomycosis patients enrolled into an ongoing phase 2b/3 clinical study. The geometric mean MIC for luliconazole was 0.00022 μg/ml against all isolates, compared to 0.0194 to 0.3107 μg/ml for the three other agents. The in vitro potency of luliconazole was maintained regardless of the dermatophyte species.
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Chacon A, Franca K, Fernandez A, Nouri K. Psychosocial impact of onychomycosis: a review. Int J Dermatol 2013; 52:1300-7. [DOI: 10.1111/ijd.12122] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Anna Chacon
- Department of Dermatology and Cutaneous Surgery; Miller School of Medicine; University of Miami; Miami FL USA
| | - Katlein Franca
- Department of Dermatology and Cutaneous Surgery; Miller School of Medicine; University of Miami; Miami FL USA
| | - Alexandra Fernandez
- Department of Dermatology and Cutaneous Surgery; Miller School of Medicine; University of Miami; Miami FL USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery; Miller School of Medicine; University of Miami; Miami FL USA
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Milobratović D, Janković S, Vukičević J, Marinković J, Janković J, Railić Z. Quality of life in patients with toenail onychomycosis. Mycoses 2013; 56:543-51. [PMID: 23496237 DOI: 10.1111/myc.12072] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 02/20/2013] [Accepted: 02/27/2013] [Indexed: 01/22/2023]
Abstract
Onychomycosis is a common, chronic fungal nail infection that can have a significant negative impact on patients' physical and social functioning and emotional well-being. This study was undertaken to assess health-related quality of life (HRQoL) in patients with toenail onychomycosis. The Onychomycosis QoL questionnaire (ONYCHO), as a disease-specific instrument, and the Short Form 36 Health Survey (SF-36) as a generic instrument, were applied in 140 consecutive patients affected by onychomycosis. Women and patients who were experiencing toenail onychomycosis for more than 2 years were reporting worse disease-specific HRQoL. The patients working in blue-collar occupations and patients with greater involvement of individual nails were more affected by onychomycosis regarding symptoms. The results of this study confirm that although onychomycosis is not a life-threatening disease, it can significantly reduce patients' QoL.
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Affiliation(s)
- Danica Milobratović
- Department of Dermatovenereology, Military Medical Centre, Belgrade, Serbia.
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Quality of Life Measures for Dermatology: Definition, Evaluation, and Interpretation. CURRENT DERMATOLOGY REPORTS 2012. [DOI: 10.1007/s13671-012-0020-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Onychomycosis (OM) is a fungal infection of the nail plate or nail bed which is highly prevalent in the general population and also responsible for significant morbidity. The condition needs to be treated in view of the physical and emotional handicap it produces. The peculiarities of the nail apparatus in health and disease lead to difficulties in being able to successfully treat this condition. Hence, the very same antifungals which produce high cure rates in skin infections are rendered less efficacious in nail disease. Low cure rates and high relapse rates even with highly efficacious antifungals have lead to an increasing interest in exploring newer treatment options which can ensure drug penetration, drug persistence, mycological cure and effective prevention of relapse. The current review aims to summarize our current status of knowledge about the treatment options for OM. It also summarizes the newer areas of research especially with respect to devices related therapies; physical measures to enhance penetration through nail; and development and evaluation of synergistic combinations.
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Affiliation(s)
- Chander Grover
- University College of Medical Sciences, Dilshad Garden, Delhi, India.
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Lasseter G, McNulty CAM, Palmer M, Yoxall H, Kibbler C. Developing best practice for fungal specimen submission - fungal audit of general practice. Mycoses 2012; 55:476-82. [DOI: 10.1111/j.1439-0507.2012.02183.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Abstract
Skindex-29 and Skindex-16 are validated measures of the effects of skin diseases on patients' quality of life. This article reviews the development of both versions of Skindex, discusses their measurement properties and interpretability, and gives examples of how they have been used and adapted for dermatologic research internationally. Studies of quality of life in patients with nonmelanoma skin cancer are described to illustrate the use of Skindex to understand quality of life and to compare effectiveness of different treatments for this highly prevalent condition.
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Abstract
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.
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Affiliation(s)
- Adam Reich
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
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Yegneswaran Prakash P, Shrijana G, Indira B. Burden of onychomycosis in rural India: Clinical and mycological assessment of the disease severity using Naildex score. Rev Iberoam Micol 2010; 27:152-3. [DOI: 10.1016/j.riam.2010.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 05/06/2010] [Accepted: 05/18/2010] [Indexed: 10/19/2022] Open
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Affiliation(s)
- David de Berker
- Bristol Dermatology Centre, Bristol Royal Infirmary, University Hospitals Bristol, Bristol, United Kingdom.
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Abstract
Patients with onychomycosis may experience significant psychosocial problems, similarly to other skin diseases. The objectives of this study were to analyse the level of stigmatisation among subjects with onychomycosis and the effect of anti-mycotic therapy on this feeling. This prospective study was carried out among 1684 patients (1050 women and 634 men, mean age 52.2 ± 15.5 years) with onychomycosis. All subjects were asked to fulfil the stigmatisation questionnaire at the baseline visit and after the completion of the anti-mycotic therapy. Stigmatisation level was assessed with reference to gender, age, education, type and duration of onychomycosis and the number of involved nails. Patients with onychomycosis reported markedly increased feeling of stigmatisation. Fingernail involvement was the major variable negatively influencing the stigmatisation level. Female patients and younger ones appeared to be more stigmatised. No significant relationships were found between stigmatisation level and education, number of involved fingernails or toenails, as well as the duration of onychomycosis. The anti-mycotic therapy resulted in significant reduction of all analysed aspects of stigmatisation to about 40% of the baseline level. Onychomycosis should be considered as an important problem for patients, significantly reducing their physical, mental and social well-being, also leading to marked stigmatisation of patients.
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Affiliation(s)
- Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland.
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