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Onychomycosis
Onychomycosis and Quality of Life
Jacek C Szepietowski
1
and Adam Reich
2
1. Vice Head, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, and Director, Institute of Immunology and Experimental
Therapy, Polish Academy of Science; 2. Post-doctorate Fellow, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University
Abstract
Onychomycosis is the most frequent nail disease, with an estimated prevalence of 3–8% in the general population. It can cause various
complications, such as bacterial cellulitis or allergic reactions, and can also significantly impair health-related quality of life (HRQoL).
Therefore, onychomycosis must be considered a significant medical problem. Numerous onychomycosis-specific questionnaires have
been developed to assess QoL in patients with onychomycosis because general health questionnaires usually only poorly identify problems
of subjects with skin and nail problems. Considering onychomycosis, it has been clearly shown that persons with fungal nail infection
experience reduced self-confidence and embarrassment, are less willing to participate in social and leisure activities, and suffer from a
number of symptoms such as discomfort when walking, foot pain or tingling, burning, and numbness.
Keywords
Onychomycosis, health-related quality of life (HRQoL), fungal infection
Disclosure: The authors have no conflicts of interest to declare.
Received: 21 January 2009 Accepted: 19 February 2009
Correspondence: Jacek C Szepietowski, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chalubinskiego 1, 50-368 Wroclaw, Poland.
jszepiet@derm.am.wroc.pl
Onychomycosis is the most frequent nail disease: it accounts for about patient psyche still remains a challenge, despite numerous studies
50% of all nail changes and for about 30% of all cutaneous fungal on methodology published during the last decade. About 70% of
infections.
1
The prevalence of onychomycosis in highly developed toenail onychomycosis patients considered their nail disease to be at
countries is estimated to be 3–8%, depending on the available least a moderate problem for them.
10
Comparison with gender- and
studies.
2–4
Toenail onychomycosis is four to seven times more frequent age-matched healthy people showed that subjects with
than fingernail disease.
5
Moreover, toenail onychomycosis frequently onychomycosis had significantly poorer ratings of general health
involves several nails, whereas usually only one or two nails are perception, bodily pain, mental health, social functioning, proportion
affected in patients with fingernail onychomycosis.
6,7
of physical appearance and functional limitations.
16,17
In a study by
our group,
14
more than 20% of patients had severely decreased QoL,
Onychomycosis is not a life-threatening disease; however, it cannot 30% had moderately altered QoL and about one-third had slightly
be considered a cosmetic problem. The majority of patients with impaired QoL, while only 14.9% of patients revealed normal health-
onychomycosis suffer from long-lasting disease, regardless of related QoL. Comparing with other chronic dermatoses (based on
whether appropriate antifungal therapy is introduced. Furthermore, it Dermatology Life Quality Index [DLQI]
18
usage), onychomycosis
has been clearly shown that infected toenails are risk factors for the impaired QoL to a lesser extent than atopic dermatitis or
development of bacterial cellulitis of the lower legs,
8
or may be a psoriasis,
14,19,20
nearly as much as seborrhoeic dermatitis
21
and to
reservoir of pathogens from which the infection spreads onto other much greater extent than androgenic alopecia
22
(see Figure 1).
skin areas.
5
On rare occasions it could even disseminate via blood, Onychomycosis was also shown (in a study performed using
resulting in sepsis and patient death.
9
Onychomycosis has also been Skindex-29) to have a lesser impact on QoL than eczema and
demonstrated to significantly decrease the quality of life (QoL) of psoriasis, but a comparable impact to non-melanoma skin cancers
patients, mainly due to its chronic course, problems with achieving and benign skin tumours.
23
complete and durable clinical and mycological cure, common
relapses and visibility to other people (especially with fingernail Patients with toenail onychomycosis report various emotional, social
disease).
10–15
Onychomycosis patients frequently experience reduced and symptom-related problems related to their nail disease
10,15,24
(see
self-confidence and embarrassment, and may be less willing to Table 1). The fear that the disease is contagious and could spread to
participate in social and leisure activities. others, difficulties in nail-cutting, problems when wearing shoes and
feelings of embarrassment were the major problems mentioned by
Impact of Onychomycosis on Quality of Life onychomycosis patients.
10,15
Similar results were documented by
Onychomycosis is not a trivial disease and can be a major problem Elewski.
24
In another large study conducted in Poland it was shown
for some, if not all, patients. An accurate estimation of its burden on that patients with onychomycosis feel markedly stigmatised,
© TOUCH BRIEFINGS 2009 85
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