A Study of the Quality of Life in Patients with Toenail Onychomycosis / 대한피부과학회지

BACKGROUND: Onychomycosis is a chronic fungal nail disease that may have a profound effect on quality of life (QOL). OBJECTIVE: The purpose of this study was to evaluate the QOL in patients with toenail onychomycosis using the onychomycosis quality of life questionnaire (ONYCHO) and to determine the factors influencing the QOL of toenail onychomycosis patients. METHODS: A total of 102 adults (mean age, 59.54 years) with toenail onychomycosis who visited our department between July 2017 and June 2018 completed the ONYCHO, which consists of statements pertaining to social, emotional, and symptom problems. All patients with toenail onychomycosis had been diagnosed by positive direct microscopic examination. RESULTS: Most of the patients demonstrated significantly reduced QOL. The degree of QOL impairment differed between subgroups. Both social (p<0.01) and emotional (p<0.05) impairments were more conspicuous in the female than in the male patients, although there were no differences according to symptoms. Patients with more extent of toenail involvement were more affected by onychomycosis in all three ONYCHO scales (p for trend<0.05). In terms of the type of toenail onychomycosis, the degrees of social (p for trend<0.05), emotional (p for trend<0.05), and symptom (p for trend<0.01) impairment were more prominent in patients with total dystrophic onychomycosis than in those with superficial white onychomycosis and distal and lateral subungual onychomycosis. A tendency toward better QOL in terms of social problems, but not emotional or symptom problems, was associated with a longer duration of the disease (B, 8.95, 95%CI, 0.99–16.91). CONCLUSION: Although toenail onychomycosis is not a life-threatening disease, it has a significantly negative impact on the overall QOL of patients, which should be a focus of concern.

A Case of Toenail Onychomycosis Due to Aspergillus terreus / 대한의진균학회지

Onychomycosis is caused by dermatophytes usually, but some species of nondermatophytic molds and yeasts are also associated with invasion of nails. Aspergillus(A.) terreus is a nondermatophytic mold which is opportunistic filamentous fungus in all environments. We report a case of onychomycosis caused by A. terreus in a 60-year-old male. The patient showed brownish yellow discoloration with hyperkeratotic change on the distal and lateral portion of both toenails. Direct microscopic examination of scraping on the potassium hydroxide preparation revealed septate hyphae and repeated cultures on Sabouraud's dextrose agar showed the velvety, cinnamon brown colonies. Biseriate and compactly columnar phialides that cover upper vesicle with conidial structure were shown in the slide culture. The DNA sequence of internal transcribed spacer (ITS) region of clinical sample was 99% match to that of A. terreus strain ATCC 20542 (GenBank accession number GU256759.1). We confirmed A. terreus by KOH mount, colony, light microscopic morphology and DNA sequence analysis. The patient was treated with 200 mg oral itraconazole daily and topical 5% amorolfine nail lacquer for 3 months.

A Case of Toenail Onychomycosis Due to Aspergillus sydowii Infection / 대한의진균학회지

Onychomycosis is caused by dermatophytes usually, but some species of nondermatophytic molds and yeasts are also associated with invasion of nails. Aspergillus sydowii is a nondermatophytic mold which is opportunistic filamentous fungus in all environments. We report a case of onychomycosis caused by A. sydowii in a 65-year-old male. The patient showed yellowish discoloration with hyperkeratotic change on the distal and lateral portion of both great toenails. Direct microscopic examination of scraping on the potassium hydroxide preparation revealed dichotomous septate hyphae and repeated cultures on Sabouraud dextrose agar showed the same blue green velvety colonies. Biseriate phialides that cover entire vesicle with conidial structure resembling Penicillium were shown in the slide culture. The DNA sequence of internal transcribed spacer (ITS) region of clinical sample was 99% match to that of A. sydowii strain XWSFJJ1 (GenBank accession number FJ461692). We confirmed A. sydowii by KOH mount, colony, light microscopic morphology and DNA sequence analysis. The patient was treated with 250 mg oral terbinafine daily and topical 5% amorolfine nail lacquer for 3 months.

Efficacy of Trichloroacetic Acid in Patients with Toenail Onychomycosis: Pilot Study with 14 Patients / 대한의진균학회지

BACKGROUND: Various methods have been employed for treatment of onychomycosis. These methods can be categorized as topical, oral, or device-related. Among them, oral therapies have been regarded as the gold standard for treatment. However, the efficacy of oral therapies on onychomycosis remains limited and safety may be an issue, leaving many patients in need of alternative treatments. As an alternative treatment for onychomycosis, topical therapies are under investigation with great interest. OBJECTIVE: We conducted an investigation on the efficacy of trichloroacetic acid (TCA) as a new therapeutic option in treatment of onychomycosis. METHODS: Fourteen patients with onychomycosis in both great toenails, which was confirmed by fungal examination, were enrolled. About 0.1 ml of 100% TCA solution was applied on one great toenail of the patients eight times at an interval of one week. The other great toenail of the patients was treated with vehicle. RESULTS: At the end of the treatment period, clinical improvement of TCA-treated great toenails with onychomycosis was observed in eleven out of 14 patients. By contrast, no clinical improvement was observed in vehicle-treated great toenails with onychomycosis. Irritant contact dermatitis of the periungual nail folds occurred in 29% as an adverse effect. CONCLUSIONS: Topical solution of TCA may become a new therapeutic option for treatment of patients with onychomycosis who desire alternatives to oral antifungal agents.

The Compliance of Oral Antifungal Therapy in the Patients with Toenail Onychomycosis in Daegu Area: Comparison between Terbinafine Continuous Therapy and Itraconazole Pulse Therapy / 대한의진균학회지

BACKGROUND: The treatment of toenail onychomycosis requires a long term oral medication of antifungal agent, and its compliance is one of the important factors for the treatment of toenail onychomycosis. OBJECTIVE: The purpose of this study was to evaluate compliance of terbinafine continuous therapy group (C group) and itraconazole pulse therapy group (P group), and to analyze the causes of stopping the treatment. METHODS: The medical records of 387 patients (C group: 177, P group: 210) with toenail onychomycosis were analyzed. The cause to stop the treatment was investigated among the drop-out patients by selfassessment questionnaires or phone calls. RESULTS: One hundred and fifty eight patients (40.8%) of the 387 patients with toenail onychomycosis completed their treatment courses, and compliance was higher in university hospital group (59.5%) than in private clinic group (20.9%). The compliance of P group (50.9%) was significantly higher than that of C group (28.8%, p<0.05). As to age group, compliance was relatively low at age group of the fourth and fifth decade in total patients and C group, and at age group of the third, fourth and fifth decade in P group. There were no significant differences between male and female patients in P group, but the compliance of the male patients (34.7%) was higher than that of female patients (21.5%) in C group. The compliance of the patients who had toenail onychomycosis for a year and more than one year (58.3%) was higher than that of patients for less than one year duration (37.5%). One hundred and seventy nine patients out of the 229 patients (C group: 101, P group: 78) who stopped the treatment, responded to self-assessment questionnaire or phone calls. Among 101 patients who responded in C group, 64 patients (63.4%) stopped the treatment within 1 month, 32 patients (31.7%) within 2 months. Among 78 patients who responded in P group, 68 patients (87.2%) stopped the treatment within 1 month, and 10 patients (12.8%) within 2 months. The causes of stopping the treatment were "lack of time to visit clinic" (29.4%), good response (24.9%), far a long distance to the clinic (18.1%), etc., in order. CONCLUSION: For the better choice of therapy, dermatologist must consider age, sex, and disease duration, select the treatment method, and explain the course of treatment to the patients. So do that, we can increase the compliance of patients with toenail onychomycosis.

The Compliance of Oral Antifungal Therapy in the Patients with Toenail Onychomycosis in Daegu Area: Comparison between Terbinafine Continuous Therapy and Itraconazole Pulse Therapy / 대한의진균학회지

BACKGROUND: The treatment of toenail onychomycosis requires a long term oral medication of antifungal agent, and its compliance is one of the important factors for the treatment of toenail onychomycosis. OBJECTIVE: The purpose of this study was to evaluate compliance of terbinafine continuous therapy group (C group) and itraconazole pulse therapy group (P group), and to analyze the causes of stopping the treatment. METHODS: The medical records of 387 patients (C group: 177, P group: 210) with toenail onychomycosis were analyzed. The cause to stop the treatment was investigated among the drop-out patients by selfassessment questionnaires or phone calls. RESULTS: One hundred and fifty eight patients (40.8%) of the 387 patients with toenail onychomycosis completed their treatment courses, and compliance was higher in university hospital group (59.5%) than in private clinic group (20.9%). The compliance of P group (50.9%) was significantly higher than that of C group (28.8%, p<0.05). As to age group, compliance was relatively low at age group of the fourth and fifth decade in total patients and C group, and at age group of the third, fourth and fifth decade in P group. There were no significant differences between male and female patients in P group, but the compliance of the male patients (34.7%) was higher than that of female patients (21.5%) in C group. The compliance of the patients who had toenail onychomycosis for a year and more than one year (58.3%) was higher than that of patients for less than one year duration (37.5%). One hundred and seventy nine patients out of the 229 patients (C group: 101, P group: 78) who stopped the treatment, responded to self-assessment questionnaire or phone calls. Among 101 patients who responded in C group, 64 patients (63.4%) stopped the treatment within 1 month, 32 patients (31.7%) within 2 months. Among 78 patients who responded in P group, 68 patients (87.2%) stopped the treatment within 1 month, and 10 patients (12.8%) within 2 months. The causes of stopping the treatment were "lack of time to visit clinic" (29.4%), good response (24.9%), far a long distance to the clinic (18.1%), etc., in order. CONCLUSION: For the better choice of therapy, dermatologist must consider age, sex, and disease duration, select the treatment method, and explain the course of treatment to the patients. So do that, we can increase the compliance of patients with toenail onychomycosis.

Four Cases of Toenail Onychomycosis Caused by Scopulariopsis brevicaulis / 대한의진균학회지

Although dermatophytes are still the main etiologic agents of onychomycosis, some species of nondermatophytic molds and yeasts are also capable of invading the nails. Scopulariopsis (S.) brevicaulis is a nondermatophytic mold which is saprophytic fungus in soil. We report four cases of toenail onychomycosis caused by S. brevicaulis in a 42-year-old male, a 46-year-old male, a 37-year-old male, and a 64-year-old male. Three patients presented with a typical distal subungual onychomycosis and one case was proximal subungual onychomycosis. Direct microscopic examination of scrapings on the potassium hydroxide preparation revealed fungal elements in all cases. Cultures from toenail lesions of the all patients on Sabouraud dextrose agar showed a typical brown colony with powdery surface of S. brevicaulis. Numerous branched conidiophores with chains of lemon-shaped conidia with rough walled were observed in slide culture and scanning electron microscopy (SEM). We confirmed S. brevicaulis by colony, light microscopic morphology and SEM.

Assessment of Quality of Life in Patient with Toenail Onychomycosis in Korea / 대한의진균학회지

BACKGROUND: Onychomycosis, especially toenail onychomycosis has become one of the common fungal infection and has historically been regarded as a cosmetic rather than medical problem by many patients, even by physicians. Recently, however, there are several reports that this is a refractory disease which may cause a deleterious effect on patients' quality of life (QOL). OBJECTIVE: The purpose of this study was to investigate the impact of toenail onychomycosis on QOL in Korea and to assess the changes of QOL after treatment. METHODS: Total 1004 patients with toenail onychomycosis which was confirmed by clinical findings and KOH preparation were enrolled at 47 dermatologic centers in Korea, and interviewed with standardized QOL questionnaire before and after systemic antifungal treatment. Responses to the questionnaire were scored by f-point scale (0~4) and averaged, and were analyzed for 5 dimensions of emotional impact, social impact, symptom and functional impact, patients' views concerning treatment, and relationship with doctor. RESULTS: 1. Before and after treatment, the most serious impact was emotional dimension showing 1.90 and 1.30 in average score (AS), and social (AS: 1.14 and 0.83) and symptom and functional impact (AS: 1.05 and 0.92) was also affected. 2. In female rather than male, statistically more significant impact on patients' QOL was observed in all dimensions. 3. After treatment, 3 of 5 dimensions were improved significantly - emotional dimension (AS: from 1.90 to 1.30), social dimension (AS: from 1.14 to 0.83), patients' view concerning treatment(AS: from 1.34 to 1.02) 4. The degree of patients' satisfaction at the therapeutic effect was very high - 62.4% (immediately after. treatment) and 65.8% (9 months after initiation of treatment) of patients answered excellent or good. CONCLUSION: This study confirms that toenail onychomycosis has significant Impact on the overall QOL of patients. Also the effect of antifungal therapy on patients' QOL were satisfactory. Therefore, both doctor and patient should pay more attention to the treatment of onychomycosis.