Szepietowski_subbed.qxp 19/5/09 3:00 pm Page 86
Onychomycosis
Figure 1: Comparison of Health-related Quality of Life in the psychosocial ramifications were directly related to the number
Onychomycosis and Other Common Skin Diseases
of toenails involved: patients with five or more toenails involved
Among Polish Populations According to the Dermatology
Life Quality Index
14,18–22
experienced more psychosocial effects than those with four or
fewer toenails infected. Furthermore, Drake et al.
27
noted that
24
patients with whole-nail onychomycosis were significantly more
emotionally, socially and physically affected by the disease than
20
patients who had half-nail involvement. Long duration of toenail
onychomycosis and involvement of five or more toenails
16 significantly impaired emotional and physical – but not social –
dimensions of QoL assessment.
27
Co-existing fingernail involvement
12 was another important parameter significantly altering QoL in
DLQI score
subjects with toenail onychomycosis. These patients demonstrated
8
reduced QoL in all domains, as shown by our group.
15
Among the
studied parameters, family history of onychomycosis and type of
4
onychomycosis seemed to be less meaningful.
15
0
Atopic Psoriasis Seborrhoeic Onychomycosis Androgenic
Several studies have reported that improvement of QoL level is strictly
dermatitis dermatitis alopecia
connected to improvement or cure of infected nails.
23,28–31
In
consequence, patients satisfied by their treatment had better QoL.
27
Table 1: Major Problems of Patients with
Toenail Onychomycosis
10,15,24
However, reoccurrence of the disease resulted in a greater decrease
of QoL compared with patients contracting the disease for the first
time who had not previously been treated for onychomycosis.
15
Problems Percentage of Patients
Fear that the disease will spread to others 31–96
Feeling that other people find it unpleasant to look 93
Onychomycosis was more likely to cause embarrassment in women
at infected nails
(83%) than in men (71%). Women felt severely embarrassed more
Difficulties when cutting nails 75–86 frequently than men (44 versus 26%).
10,11
Several groups observed,
Problems when wearing shoes 82 that women also had lower general QoL compared with men.
14,15,27–29
Spending a lot of money to treat the nail disease 75
Another factor affecting QoL in onychomycosis patients is age;
Embarrassment 44–74
however, its impact is more difficult to measure directly because older
Toe pain 41–60
patients are usually more ill anyway and have poorer scoring in
Avoidance of social situations 15–18
generic scales.
28
However, older patients with onychomycosis were
shown to have lower scoring regarding social problems compared
especially those with fingernail involvement.
25
The most important with healthy counterparts.
27
On the other hand, it seems probable that
issues raised by the patients were the conviction that other people onychomycosis could be less emotionally scarring for older subjects
stared at the affected nails and feelings of unattractiveness.
25
because appearance is generally less important to this patient group
Remarkably, antimycotic therapy resulted in a significant reduction of compared with younger people.
stigmatisation, to about 40% of the baseline level.
25
Interestingly, nationality, place of residence (i.e. urban versus rural)
Up to 60% of onychomycosis subjects report toe pain of some and the education level of patients with toenail onychomycosis were
degree
15
(see Table 1). Moreover, the Achilles Foot-Screening Project other important parameters influencing QoL in onychomycosis. In the
revealed that 51% of investigated patients with onychomycosis multinational study by Drake et al.,
27
the most affected populations
suffered from discomfort when walking, 33% had foot pain, 28% were were patients from Germany and the US. In addition, replication of the
embarrassed by their nail condition and 13% were limited in terms of Achilles Foot-Screening Project in Asia documented that toenail
work or other activities because of the affected toenails.
26
In addition, onychomycosis had less impact on QoL than that reported in
Drake et al.
10
observed that all studied patients with toenail European countries, although the problems that were identified were
onychomycosis experienced at least one of the following sensations very similar.
12
As for place of residence and education, patients living
within the toes: tingling, burning, numbness, pressure or discomfort. in towns or big cities, as well as those with a higher education level,
Drake et al.
10
also found that more than 95% of onychomycosis were more emotionally and socially affected by onychomycosis, while
subjects would be willing to pay for an antifungal therapy with an subjects living in the countryside, as well as those with a poorer
80% cure rate, even if their insurance did not cover the cost. education level, more often underlined problems connected to the
Interestingly, 57% of patients were still willing to pay for the physical symptoms of the disease.
14,15
treatment themselves even when the theoretical cure rate was
reduced to 35%.
10
Conclusions
Onychomycosis is a common disease with a marked negative impact
However, the degree of influence of toenail onychomycosis on on patient wellbeing. Based on our own experience and literature
patient QoL depends on several disease-related and demographic data, we conclude that onychomycosis causes a significant reduction
parameters, mainly duration of onychomycosis, number of involved in the QoL of the majority of patients. QoL is impaired in all domains,
toenails, age and education. Elewski
24
observed that patients who including physical, mental and social functioning. QoL literature
had suffered from onychomycosis for 10 years or longer indicated clearly shows that onychomycosis is a serious medical problem that
that their disease had more psychosocial than physical impact, and requires careful consideration by physicians. ■
86 EUROPEAN DERMATOLOGY
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