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Inoue T, Watabe D, Furukawa M, Goto M, Kamada H, Sato Y, Arakawa N, Miura S, Sato T, Yasuhira S, Tsunemi Y, Amano H. Prevalence and risk factors for onychomycosis in acute care dermatology wards. J Dermatol 2024. [PMID: 38558466 DOI: 10.1111/1346-8138.17211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 03/02/2024] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
We conducted a cross-sectional study on the clinical and mycological features of onychomycosis in patients in the dermatology ward of Iwate Medical University Hospital, an acute care hospital. Of the 226 hospitalized patients, 73 (32.3%) had onychomycosis and 61 (26.9%) were diagnosed after admission. The toenail was the most common site of onychomycosis (94.5%), while toenail plus fingernail and fingernail only sites were 4.1% and 1.4%, respectively. The most common clinical form of onychomycosis was distal and lateral subungual onychomycosis (79%) with Trichophyton rubrum (66.7%) and T. interdigitale (27.8%) as the main causative species. Patients who were older, or had neurological diseases, or needed stretcher transfer had onychomycosis significantly more frequently than those who were obese, had diabetes, cancer, needed an escort for moving, or could move independently. Our study suggests that there is likely to be a significant number of untreated and undiagnosed patients with onychomycosis in acute care hospitals. Therefore, it is necessary to increase awareness of onychomycosis in hospitals.
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Affiliation(s)
- Tsuyoshi Inoue
- Department of Dermatology, Iwate Medical University School of Medicine, Iwate, Japan
| | - Daisuke Watabe
- Department of Dermatology, Iwate Medical University School of Medicine, Iwate, Japan
| | - Maiko Furukawa
- Department of Dermatology, Iwate Medical University School of Medicine, Iwate, Japan
| | - Maki Goto
- Department of Dermatology, Iwate Medical University School of Medicine, Iwate, Japan
| | - Hirofumi Kamada
- Department of Dermatology, Iwate Medical University School of Medicine, Iwate, Japan
| | - Yuri Sato
- Department of Dermatology, Iwate Medical University School of Medicine, Iwate, Japan
| | - Nobuyuki Arakawa
- Department of Dermatology, Iwate Medical University School of Medicine, Iwate, Japan
| | - Shinpei Miura
- Department of Dermatology, Iwate Medical University School of Medicine, Iwate, Japan
| | - Toshiki Sato
- Department of Dermatology, Iwate Medical University School of Medicine, Iwate, Japan
| | - Shinji Yasuhira
- Division of Tumor Biology, Institute for Biomedical Sciences, Iwate Medical University, Shiwa-gun, Japan
| | - Yuichiro Tsunemi
- Department of Dermatology, Saitama Medical University, Saitama, Japan
| | - Hiroo Amano
- Department of Dermatology, Iwate Medical University School of Medicine, Iwate, Japan
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2
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Mahajan K, Grover C, Relhan V, Tahiliani S, Singal A, Shenoy MM, Jakhar D. Nail Society of India (NSI) Recommendations for Pharmacologic Therapy of Onychomycosis. Indian Dermatol Online J 2023; 14:330-341. [PMID: 37266092 PMCID: PMC10231711 DOI: 10.4103/idoj.idoj_355_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/30/2022] [Accepted: 12/11/2022] [Indexed: 06/03/2023] Open
Abstract
Onychomycosis (OM) is the commonest cause of dystrophic nails, responsible for upto 50% of cases. Apart from significantly damaging the nails, quality of life, and self-image of the sufferer, it also acts as a reservoir of fungal infections carrying important implications for emerging recalcitrant dermatophytoses. Treatment of OM is based on guidelines released almost a decade back, in addition to published literature and personal preferences. Hence, an expert group of nail society of India (NSI) worked towards drafting these guidelines aimed at compiling recommendations for pharmacologic treatment of OM, based on scientific evidence, along with practical experience. The group did an extensive analysis of available English language literature on OM published during the period 2014-2022. The evidence compiled was graded and discussed to derive consensus recommendations for practice. Special focus was placed on combination therapies and adjunct therapies, including experience of members, to improve treatment outcomes.
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Affiliation(s)
- Khushbu Mahajan
- Consultant Dermatologist, Mahajan Skin Centre and Kubba Skin Clinic, Delhi, India
| | - Chander Grover
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Vineet Relhan
- Department of Dermatology and STD, Maulana Azad Medical College and LN Hospital, Delhi, India
| | - Sushil Tahiliani
- Consultant Dermatologist, Hinduja Hospital and MRC, Dr Tahiliani’s Skin Clinic, Mumbai, Maharashtra, India
| | - Archana Singal
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - M Manjunath Shenoy
- Department of Dermatology, Venereology and Leprosy, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Deepak Jakhar
- Consultant Dermatologist, Dermosphere Skin Clinic, Delhi, India
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3
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Translation and Cross-Cultural Adaptation of Quality of Life Scale in Patients with Onychomycosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115793. [PMID: 34071246 PMCID: PMC8198911 DOI: 10.3390/ijerph18115793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Onychomycosis (OM) is a fungal nail infection, considered a risk factor for diabetic foot ulcers. It is associated with changes in quality of life, in terms of pain, self-confidence and self-esteem. The aim was to translate and adapt the OM quality of life questionnaire "OnyCOE-tTM-Quality Of Life Questionnaire Onychomycosis (Nail Fungal Condition)". (2) Methods: This study followed the guidelines proposed by Beaton et al. (2000), where two English to Portuguese translations were performed and, after an expert consensus, a common version was obtained. This was followed by two back-translations. The expert committee achieved semantic equivalence, idioms and concepts. The pre-test was applied to 49 people. The final version and processed data were sent to the authors. (3) Results: We adapted terms semantically, modified statements syntactically, altering items from interrogative to affirmative. (4) Conclusions: The translated version of the "Quality of life-Onychomycosis" questionnaire suggested that it can be used for further studies to test validity and reliability in this population.
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Treatment Outcome with Fosravuconazole for Onychomycosis. Mycopathologia 2021; 186:259-267. [PMID: 33754205 DOI: 10.1007/s11046-021-00540-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/02/2021] [Indexed: 10/20/2022]
Abstract
Fosravuconazole L-lysine ethanolate (F-RVCZ), a ravuconazole prodrug, is a newly available agent with high expectations for efficacy in the treatment of onychomycosis. However, clinical data regarding the efficacy of F-RVCZ are limited because the drug was launched only in Japan in 2018. Therefore, we analyzed the outcome of F-RVCZ therapy in the treatment of onychomycosis at outpatient dermatology clinics in Japan. We examined data for 109 patients (68 male, 41 female) with varying clinical type, including total dystrophic onychomycosis and dermatophytoma, and a wide range of age groups, including the elderly. The complete cure rate at 12 weeks was 6.4% (7/109) and 67.9% (74/109) at the last visit (mean time to last visit: 32 ± 14.2 weeks). Mean rate of improvement in the affected nail area was 49.1 ± 23.3% at 12 weeks and 86.8 ± 22.4% at the last visit. Efficacy at 12 weeks and the last visit, respectively, was as follows: none, 4 cases and 1 case; slight, 35 cases and 4 cases; moderate, 51 cases and 21 cases; significant, 12 cases and 9 cases; complete cure, 7 cases and 74 cases. There were no serious adverse events. This retrospective survey was the first large-scale analysis of actual clinical practice outcomes and had minimal exclusions. Compared to previous reports, our results demonstrated excellent efficacy of F-RVCZ therapy in a variety of patients. Considering our results and the ease of oral administration (1 capsule/day for 12 weeks) and few adverse events, F-RVCZ therapy appears to be a useful option for the treatment of onychomycosis.
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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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Iozumi K, Abe M, Ito Y, Uesugi T, Onoduka T, Kato I, Kato F, Kodama K, Takahashi H, Takeda O, Tomizawa K, Nomiyama T, Fujii M, Mayama J, Muramoto F, Yasuda H, Yamanaka K, Sato T, Oh-I T, Kasai H, Tsuboi R, Hattori N, Maruyama R, Omi T, Shimoyama H, Sei Y, Nakasu I, Nishimoto S, Hata Y, Mochizuki T, Fukuzawa M, Seishima M, Sugiura K, Katayama I, Yamamoto O, Shindo M, Kiryu H, Kusuhara M, Takenaka M, Watanabe S. Efficacy of long-term treatment with efinaconazole 10% solution in patients with onychomycosis, including severe cases: A multicenter, single-arm study. J Dermatol 2019; 46:641-651. [PMID: 31206779 PMCID: PMC6771904 DOI: 10.1111/1346-8138.14935] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/01/2019] [Indexed: 11/28/2022]
Abstract
We evaluated the efficacy of efinaconazole 10% topical solution in long‐term use, for up to 72 weeks, for onychomycosis, including severe cases. Among 605 participants, 219 patients diagnosed as having onychomycosis were evaluated for the efficacy of efinaconazole. The treatment success rate (<10% clinical involvement of the target toenail) at the final assessment time point was 56.6%, the complete cure rate was 31.1% and the mycological cure rate was 61.6%, all of which increased over time, demonstrating that continuous application contributed to the improvement of cure rate. Even in severe cases, reduction of the affected nail area was observed, showing the potential efficacy of the treatment. Responses to a quality of life questionnaire among patients with onychomycosis, OnyCOE‐t, suggested that efinaconazole treatment improved the patients’ quality of life. The incidence of adverse drug reaction in the patients eligible for the assessment was 6.3%, and this developed only in the administration site in all cases. No systemic adverse event was observed. In addition, no increase in the incidence of adverse drug reaction due to long‐term use was found. Efinaconazole therapy was proved to exhibit excellent balance between efficacy and safety, and thus may serve as a useful treatment option for onychomycosis.
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Affiliation(s)
- Ken Iozumi
- Department of Dermatology, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | | | | | | | | | - Ichiro Kato
- Eniwa Station Dermatology Clinic, Hokkaido, Japan
| | | | | | | | - Osamu Takeda
- Takeda Dermatological Skin Care Clinic, Hokkaido, Japan
| | | | | | - Mizue Fujii
- Department of Dermatology, Asahikawa Medical University Hospital, Hokkaido, Japan
| | - Jun Mayama
- Chitose Dermatology and Plastic Surgery Clinic, Hokkaido, Japan
| | | | | | | | - Tomotaka Sato
- Department of Dermatology, Teikyo University Chiba Medical Center, Chiba, Japan.,Department of Dermatology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | | | - Hiroko Kasai
- Department of Dermatology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Ryoji Tsuboi
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | | | | | - Tokuya Omi
- Queen's Square Medical Center, Kanagawa, Japan
| | - Harunari Shimoyama
- Department of Dermatology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Yoshihiro Sei
- Department of Dermatology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | | | - Shuhei Nishimoto
- Department of Dermatology, Saiseikai Kanagawa Hospital, Kanagawa, Japan
| | - Yasuki Hata
- Department of Dermatology, Saiseikai Kanagawa Hospital, Kanagawa, Japan.,Kanagawa Hata Dermatology Clinic, Kanagawa, Japan
| | - Takashi Mochizuki
- Department of Dermatology, Kanazawa Medical University, Ishikawa, Japan
| | - Masao Fukuzawa
- Department of Dermatology, Ina Central Hospital, Nagano, Japan
| | - Mariko Seishima
- Department of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazumitsu Sugiura
- Department of Dermatology, Fujita Health University School of Medicine, Aichi, Japan
| | | | - Osamu Yamamoto
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, Tottori University Faculty of Medicine, Tottori, Japan
| | - Masahisa Shindo
- Department of Dermatology, National Hospital Organization Hamada Medical Center, Shimane, Japan
| | | | | | - Motoi Takenaka
- Department of Dermatology, Nagasaki University Hospital, Nagasaki, Japan
| | - Shinichi Watanabe
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
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Gupta AK, Carviel J, Shear NH. Onychomycosis and Chronic Fungal Disease: Exploiting a Commensal Disguise to Stage a Covert Invasion. J Cutan Med Surg 2017; 22:318-322. [PMID: 29191054 DOI: 10.1177/1203475417745827] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Onychomycosis is a chronic fungal infection that is recalcitrant to treatment and often results in relapse. New evidence suggests that disease prognosis may be linked to pathogens manipulating host immune responses. Therefore, individuals with specific mutations, including those affecting pattern recognition receptors or the interleukin (IL)-17 and IL-22 pathways, may be more susceptible to infection. Moreover, it is recommended that those with a family history of immune mutations or predisposition to fungal disease be treated aggressively for onychomycosis prior to symptom progression. In addition, incorporating genetic testing and new investigational therapy such as IL-33 and interferon-γ may improve treatment outcome.
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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, London, Ontario, Canada
| | | | - Neil H Shear
- 3 Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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