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Shah VK, Desai AD, Lipner SR. Retrospective Analysis of Onychomycosis Risk Factors Using the 2003-2014 National Inpatient Sample. Dermatol Pract Concept 2024; 14:dpc.1402a74. [PMID: 38810060 PMCID: PMC11135940 DOI: 10.5826/dpc.1402a74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2023] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Onychomycosis, a fungal nail infection, is associated with significant morbidity and negative impact on quality of life. Therefore, understanding associated risk factors may inform onychomycosis screening guidelines. OBJECTIVES This retrospective study investigated common demographic and comorbidity risk factors among hospitalized patients using the National Inpatient Sample. METHODS The 2003-2014 National Inpatient Sample (NIS) database was used to identify onychomycosis cases and age and sex matched controls in a 1:2 ratio. Chi-square tests and T-tests for independent samples were utilized to compare categorical and continuous patient factors. Demographic and comorbidity variables significant (P < 0.05) on univariate analysis were analyzed via a multivariate regression model with Bonferroni correction (P < 0.0029). RESULTS 119,662 onychomycosis cases and 239,324 controls were identified. Compared to controls, onychomycosis patients frequently were White (69.0% versus 68.0%; P < 0.001), Black (17.9% versus 5.8%; P < 0.0001), and insured by Medicare or Medicaid (80.1% versus 71.1%; P < 0.0001). Patients had greater hospital stays (9.69 versus 5.39 days; P < 0.0001) and costs ($39,925 versus $36,720; P < 0.001) compared to controls. On multivariate analysis, onychomycosis was commonly associated with tinea pedis (odds ratio [OR]: 111.993; P < 0.0001), human immunodeficiency virus (OR: 4.372; P < 0.001), venous insufficiency (OR: 6.916; P < 0.0001), and psoriasis (OR: 3.668; P < 0.001). CONCLUSIONS Onychomycosis patients had longer hospital stays and greater costs compared to controls. Black patients were disproportionately represented among cases compared to controls. Onychomycosis was associated with tinea pedis, venous insufficiency, human immunodeficiency virus, psoriasis, obesity (body mass index [BMI] ≥ 30 kg/m2), peripheral vascular disease, and diabetes with chronic complications, suggesting that inpatients with onychomycosis should be screened for these conditions.
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Affiliation(s)
- Vrusha K. Shah
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Shari R. Lipner
- Weill Cornell Medicine, Department of Dermatology, New York, NY, USA
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Albucker SJ, Falotico JM, Choo ZN, Matushansky JT, Lipner SR. Risk Factors and Treatment Trends for Onychomycosis: A Case-Control Study of Onychomycosis Patients in the All of Us Research Program. J Fungi (Basel) 2023; 9:712. [PMID: 37504701 PMCID: PMC10381528 DOI: 10.3390/jof9070712] [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: 06/01/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023] Open
Abstract
Introda significant: Onychomycosis is the most common nail disorder seen in clinical practice, and it may have significant impact on patient quality of life. Understanding risk factors for onychomycosis may help to devise screening and treatment guidelines for populations that are more susceptible to this infection. Using a national database, we aimed to explore associations between onychomycosis and age, sex, and underlying medical conditions, as well as to examine current onychomycosis treatment trends. Materials and Methods: We performed a nested, matched, case-control study of patients in the All of Us database aged ≥ 18 years (6 May 2018-1 January 2022). Onychomycosis cases were identified using International Classification of Diseases (ICD) and Systematized Nomenclature of Medicine (SNOMED) diagnostic codes (ICD-9 110.1, ICD-10 B35.1, SNOMED 414941008). Demographic information (i.e., age, sex, and race), treatments, and co-diagnoses for onychomycosis patients and case-controls were recorded. Wald's test applied to multivariate logistic regression was used to calculate odds ratios and p-values between onychomycosis and co-diagnoses. Additionally, 95% confidence intervals were calculated with a proportion test. Results: We included 15,760 onychomycosis patients and 47,280 matched controls. The mean age of onychomycosis patients was 64.9 years, with 54.2% female, 52.8% Non-Hispanic White, 23.0% Black, 17.8% Hispanic, and 6.3% other, which was similar to controls. Patients with onychomycosis vs. controls were more likely to have a co-diagnosis of obesity (46.4%, OR 2.59 [2.49-2.69]), tinea pedis (21.5%, OR 10.9 [10.1-11.6]), peripheral vascular disease (PVD) (14.4%, OR 3.04 [2.86-3.24]), venous insufficiency (13.4%, OR 3.38 [3.15-3.59]), venous varices (5.6%, OR 2.71 [2.47-2.97]), diabetes mellitus (5.6%, OR 3.28 [2.98-3.61]), and human immunodeficiency virus (HIV) (3.5%, OR 1.8 [1.61-2.00]) (p < 0.05, all). The most frequently prescribed oral and topical medications were terbinafine (20.9%) and ciclopirox (12.4%), respectively. The most common therapeutic procedure performed was debridement (19.3%). Over the study period, ciclopirox prescriptions (Spearman correlation 0.182, p = 0.0361) and fluconazole prescriptions increased (Spearman correlation 0.665, p = 2.44 × 10-4), and griseofulvin (Spearman correlation -0.557, p = 0.0131) and itraconazole prescriptions decreased (Spearman correlation -0.681, p = 3.32 × 10-6). Conclusions: Our study demonstrated that age, obesity, tinea pedis, PVD, venous insufficiency, diabetes mellitus, and HIV were significant risk factors for onychomycosis. In addition, the most frequent oral and topical onychomycosis medications prescribed were terbinafine and ciclopirox, likely reflective of efficacy and cost considerations. Identifying and managing these risk factors is essential to preventing onychomycosis' primary infections and recurrences and improving treatment efficacy.
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Affiliation(s)
| | - Julianne M Falotico
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA
| | - Zi-Ning Choo
- Weill Cornell Medical College, New York, NY 10021, USA
| | | | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY 10021, USA
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Kiehl L, Ellebrecht LH, Recke AL, Kahle B. Literaturübersicht zu Veränderungen der Zehennägel bei chronischer venöser Insuffizienz. PHLEBOLOGIE 2023. [DOI: 10.1055/a-1930-9826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
ZusammenfassungDas Patientenkollektiv einer phlebologischen Sprechstunde weist häufig pathologisch veränderte Zehennägel auf. Es stellt sich die Frage, ob ein Zusammenhang zwischen chronischer venöser Insuffizienz und einer Onychodystrophie besteht. Denkbar sind sowohl nichtmykotische Nagelwachstumsstörungen als auch eine Prädisposition für Onychomykosen durch eine Minderperfusion im Rahmen der venösen Insuffizienz. Die wenige Literatur, die es zu dieser Thematik gibt, zeigt unterschiedliche Ergebnisse, welche hier genauer erläutert werden.
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Affiliation(s)
- Lisa Kiehl
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Deutschland
| | - Lena-Henrike Ellebrecht
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Deutschland
| | - Anna Lena Recke
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Deutschland
| | - Birgit Kahle
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Deutschland
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Kılınç F, Akbaş A, Şener S, Hayran Y, Aktaş A. Cutaneous findings in patients with chronic venous insufficiency. J Cosmet Dermatol 2021; 21:2106-2112. [PMID: 34240795 DOI: 10.1111/jocd.14337] [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: 05/25/2021] [Revised: 06/24/2021] [Accepted: 07/02/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Venous hypertension causes many different cutaneous findings such as varicosities, telangiectasia, edema, and pigmentation, dermatitis, and venous ulcers on the skin. OBJECTIVE This study aims to investigate the cutaneous signs and symptoms of chronic venous insufficiency (CVI) and to examine their contribution to early diagnosis. METHODS A total of 150 patients were included in the study who applied to the dermatology outpatient clinic and were diagnosed with skin disease related to CVI or had skin findings. Patient's age, gender, complaints, occupation, additional diseases, drug usage, history of prolonged standing and travel, smoking habit, number of pregnancies, history of varicose veins in the family, dermatological diagnosis/findings, and venous Doppler ultrasonography reports were examined retrospectively. RESULTS 56% of patients were women. Mean age was 56.69 ± 13.6 years. Overall, 82.7% of total patients had at least one skin finding. The most frequent skin findings except varicose veins were insufficiency dermatitis accounted for 32.7% of patients, telangiectasia, and pigmentation which were comprised 25.3%, 19.3% of the total number of patients respectively. In addition to this, 48.7% of patients had itching problems and 32.7% had pain. Moreover, 46% of patients presented superficial vein insufficiency, while 8.7% had deep vein insufficiency. For 47.3% of patients, vein diameter dilation was observed and 11.3% suffered from perforating vein insufficiency. In terms of Clinical-Etiologic-Anatomic-Pathophysiologic (CEAP) classification, scores of 52% of the patients were C3 and lower, while scores of 48% of total patients were C4a and higher. CONCLUSIONS Early diagnosis and treatment of chronic venous insufficiency could prevent further chronic processes such as venous ulceration which is an advanced CVI finding. Thus, assessing the early skin findings might be important to identify the underlying venous insufficiency disease.
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Affiliation(s)
| | - Ayşe Akbaş
- Ankara City Hospital, Dermatology, Ankara, Turkey
| | | | | | - Akın Aktaş
- Yildirim beyazit University, Medical Faculty, Dermatology, Ankara, Turkey
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Bajuk V, Leskovec NK, Ručigaj TP, Suhodolčan AB, Dolenc-Voljč M. Toenail alterations in chronic venous disease patients are not always of mycotic origin. Phlebology 2018; 34:421-426. [PMID: 30541415 DOI: 10.1177/0268355518818619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The prevalence of toenail alterations in chronic venous disease has only rarely been studied. We aimed to establish the frequency and clinical characteristics of toenail onychomycosis in chronic venous disease. Methods We included 80 adult patients, in all stages of chronic venous disease. Onychomycosis was confirmed by mycological examination. The clinical type of onychomycosis and the onychomycosis severity index were determined. Clinical characteristics of non-fungal nail changes were also analyzed. Results We included 58 women and 22 men, with a mean age of 67.0 years. Pathological toenail changes were observed in 83.8% of patients. Onychomycosis was confirmed in 33.8% of all patients and was more frequent in higher clinical stages of chronic venous disease (p = 0.009). Trichophyton rubrum was the leading causative pathogen. Disto-lateral onychomycosis was most commonly present. Average onychomycosis severity index was 23.1. Conclusion Onychomycosis accounted for 40% of all toenail alterations. Patients with chronic venous disease often have severe and difficult to treat toenail onychomycosis.
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Affiliation(s)
- Vid Bajuk
- 1 Department of Dermatovenereology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nada Kecelj Leskovec
- 1 Department of Dermatovenereology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,2 Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tanja Planinšek Ručigaj
- 1 Department of Dermatovenereology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Mateja Dolenc-Voljč
- 1 Department of Dermatovenereology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,2 Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Bang CH, Yoon JW, Lee HJ, Lee JY, Park YM, Lee SJ, Lee JH. Evaluation of relationships between onychomycosis and vascular diseases using sequential pattern mining. Sci Rep 2018; 8:17840. [PMID: 30552340 PMCID: PMC6294792 DOI: 10.1038/s41598-018-35909-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 11/13/2018] [Indexed: 11/17/2022] Open
Abstract
Onychomycosis (OM) is a common nail disease. Although controversial, vascular diseases are considered independent predictors of OM and vice versa. Sequential pattern mining (SPM) has not been previously used for statistical analysis in dermatology, but it is an efficient method for identifying frequent association rules in multiple sequential data sets. The aim of our study was to identify the relationship between OM and vascular diseases in the real world through a population-based study using SPM. We obtained population-based data recorded from 2002 to 2013 by the Health Insurance Research and Assessment Agency. Cases of vascular-related disease and OM were identified using the diagnostic codes of the International Classification of Diseases 10th Revision, version 2010. SPM measures were based on comorbidity and duration values. We estimated 3-year risk for progression from OM to vascular disease and vice versa using logistic regression. Patients with varicose veins and peripheral vascular disease had higher OM comorbidity (comorbidity: 1.26% and 0.69%, respectively) than did those with other vascular diseases. Patients diagnosed with varicose veins and peripheral vascular disease were diagnosed with OM after 25.50 and 55.10 days, respectively, which was a shorter duration than that observed for other diseases. Patients with OM were at higher risk for peripheral vascular disease (adjusted odds ratio (aOR) 1.199 [95% confidence interval (CI) 1.151–1.249]) and varicose veins (aOR 1.150 [95% CI 1.063–1.245]). Patients with peripheral vascular disease (aOR 1.128 [95% CI 1.081–1.177]) were at higher risk for OM, while patients with varicose veins had no significant risk for OM. Careful consideration of varicose veins or peripheral vascular disease is required for proper management of comorbidities in patients with OM.
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Affiliation(s)
- Chul Hwan Bang
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Woong Yoon
- Department of Business Management, Kwangwoon University, Seoul, Korea
| | - Hyun Ji Lee
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Young Lee
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Min Park
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Suk Jun Lee
- Department of Business Management, Kwangwoon University, Seoul, Korea.
| | - Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Moreno-Coutiño G, Fernández-Martínez R, Sánchez-Moreno EC, Lozano-Platonoff A, Rodríguez-Salinas CI, Rosas-González A, Sánchez-Mojica CA, Arenas R. Onychodystrophy: A possible marker for peripheral artery disease. JOURNAL OF VASCULAR NURSING 2017; 34:24-6. [PMID: 26897349 DOI: 10.1016/j.jvn.2015.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/23/2015] [Accepted: 10/26/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Peripheral artery disease (PAD) is quite common, particularly among the elderly. In advanced phases, it has an important impact in the quality of life, so it is recommended to identify this disease on early stages. Onychodystrophy is a deformity of the nail plate of any origin. Up to 50% are caused by fungal infection, the rest is mainly secondary to inflammatory processes. Nail inspection is a very accessible task, and valuation of PAD with the ankle-brachial index (ABI) is a noninvasive affordable technique. PATIENTS AND METHODS One hundred two self-reported healthy participants were recruited, and the ABI was obtained, as well as inspection of the toenails in search of onychodystrophy. RESULTS AND CONCLUSIONS Sixty-seven patients had abnormal ABI measurements. Of these, 39 were diagnosed as having onychodystrophy. These results are statistically significant to support the fact that onychodystrophy may be an early marker of asymptomatic PAD, allowing prompt intervention to ameliorate or stop disease progression.
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Affiliation(s)
| | | | | | | | | | - Abraham Rosas-González
- Facultad de Medicina, UNAM, Hospital General "Dr. Manuel Gea González", Tlalpan, México D.F
| | | | - Roberto Arenas
- Mycology Section, Hospital General "Dr. Manuel Gea González", Tlalpan, México D.F
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Abstract
The prevalence of onychomycosis has been estimated at approximately 6.48% (95% confidence interval 6.09–6.88%) within the Canadian population. Dermatophytes are the most commonly cultured organisms, appearing in approximately 75 to 91% of nails with fungal involvement, with Trichophyton rubrum and Tricophyton mentagrophytes most commonly isolated. However, Candida spp and nondermatophyte molds are also sometimes cultured. The most common presentation is distal and lateral subungual onychomycosis (DLSO), which can involve 75% of patients with pedal onychomycosis. The distribution of DLSO, superficial white onychomycosis, and proximal subungual onychomycosis (PSO) has been reported to be 360:59:1 in patients with mycologic confirmation of onychomycosis; however, some reported that the incidence of PSO is slightly higher in immunocompromised individuals. Age, gender, family history, and the presence of tinea pedis are all elements associated with a nail fungal infection. In addition, many conditions, including diabetes mellitus, immune disorders, and vascular disease, have been associated with the presence of onychomycosis. When choosing the best treatment regimen for individuals with onychomycosis, it is very important to consider all of the factors involved, including the infecting species, the presentation of the disease, the level of disease progression, and its predisposing factors.
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Affiliation(s)
- Ronald B. Vender
- From Dermatrials Research, Hamilton, ON; McMaster University, Hamilton, ON; Lynderm Research Inc., Markham, ON; University of Toronto, Toronto, ON; and Laval University, Quebec City, PQ
| | - Charles W. Lynde
- From Dermatrials Research, Hamilton, ON; McMaster University, Hamilton, ON; Lynderm Research Inc., Markham, ON; University of Toronto, Toronto, ON; and Laval University, Quebec City, PQ
| | - Yves Poulin
- From Dermatrials Research, Hamilton, ON; McMaster University, Hamilton, ON; Lynderm Research Inc., Markham, ON; University of Toronto, Toronto, ON; and Laval University, Quebec City, PQ
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OZKAN F, OZTURK P, OZYURT K, İNCİ MF, KALENDER AM, BAKAN B, YUKSEL M. Frequency of peripheral arterial disease and venous insufficiency in toenail onychomycosis. J Dermatol 2012; 40:107-10. [DOI: 10.1111/1346-8138.12020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 09/10/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Fuat OZKAN
- Departments of Radiology; Faculty of Medicine; Kahramanmaras Sutcu Imam University; Kahramanmaras; Turkey
| | - Perihan OZTURK
- Dermatology; Faculty of Medicine; Kahramanmaras Sutcu Imam University; Kahramanmaras; Turkey
| | - Kemal OZYURT
- Dermatology; Faculty of Medicine; Kahramanmaras Sutcu Imam University; Kahramanmaras; Turkey
| | - Mehmet F. İNCİ
- Departments of Radiology; Faculty of Medicine; Kahramanmaras Sutcu Imam University; Kahramanmaras; Turkey
| | - Ali M. KALENDER
- Orthopaedic Surgery; Faculty of Medicine; Kahramanmaras Sutcu Imam University; Kahramanmaras; Turkey
| | - Betul BAKAN
- Physical Medicine and Rehabilitation; Faculty of Medicine; Kahramanmaras Sutcu Imam University; Kahramanmaras; Turkey
| | - Murvet YUKSEL
- Departments of Radiology; Faculty of Medicine; Kahramanmaras Sutcu Imam University; Kahramanmaras; Turkey
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