[Current Status of Onychomycosis Topical Therapy Conducted at Home].

　Patients usually consult a dermatologist for the treatment of onychomycosis. However, in the case of home care, visiting nurses may assist with bathing, which offers the opportunity to observe patients' feet for possible signs of onychomycosis without causing anxiety. It is estimated that more than 30% of patients receiving home care have onychomycosis. Before the approval of efinaconazole, healthcare personnel hesitated to treat onychomycosis because of: 1) possible side effects, especially liver dysfunction and pain due to repeated blood collection, as a major goal of home care is to minimize pain; and 2) the questionable efficacy of previously available antifungal medications. In addition, many patients report fear of "transmitting athlete's foot to others" and "do not want to show my dirty toenails". On the other hand, caregivers reportedly worry about "athlete's foot being transmitted to them".

[Study of Home-based Ringworm Treatment and Follow-up by Visiting Nurses and Physicians: Interventional Effects].

　The aim of this study was to assess the effects of cooperation by visiting nurses and physicians experienced in general patient care, dermatology, and podiatry for the treatment of ringworm. Questionnaires were delivered to 1184 patients receiving home-based care by one of 14 participating visiting nursing establishments with a combined capacity of 3273 patients throughout five wards of the Tokyo metropolitan area. Responses were obtained from 691 patients (participation rate, 60.2%; average age, 80.2 years). The onychomycosis morbidity rate among home care patients was 22.7%. The results showed a significant reduction in the incidence of ringworm in the intervention group, from 79.5% to 54.5% (p=0.022), and in the incidence of "foot skin infection", from 100.0% to 31.6% (p<0.001). Although the level of care deteriorated in the control group (p=0.008), there was no significant change in the intervention group. The incidence of leg pain also remained unchanged in the control group (p=0.285) but decreased in the intervention group (p=0.003). While the "degree of satisfaction with foot cleanliness" did not change significantly in the control group (p=0.260), patients in the intervention group were generally satisfied with foot cleanliness. It is necessary to take into account foot care and the effect of onychomycosis treatment vearsusu no treatment and to ensure that visiting nurses and caregivers master foot care-related treatment regimens. We suggest the need to improve the maintenance of foot care and ringworm intervention/treatment performed by physicians, nurses, and caregivers.

[Role of Pharmacists in Topical Therapy for Onychomycosis in the Home-care Setting].

　There is an urgent need to promote home medical care in Japan because of the country's superaging society. Community pharmacists are expected to play an important role as part of home medical care teams. The prevalence of nail ringworm is high among home-care patients and can cause decreases in the quality of life, including difficulty in walking due to pain caused by nail deformation and inflammation around infected nails. Nail ringworm is typically treated with oral medication. However, the condition is left untreated in many elderly patients because of the risk of drug-drug interactions or concerns about severe liver damage. Efinaconazole, a novel triazole antifungal agent, has recently become available in Japan, enabling patients with nail ringworm to be treated with a topical medication. In topical treatment, the method of application is important because of its major impact on the therapeutic effect. Therefore, pharmacists should take special care to instruct patients and caregivers on the proper use of topical efinaconazole. Adherence to oral medication can be easily monitored by checking the number of tablets or capsules remaining, but adherence to topical medication regimens is more difficult to assess because the remaining amount cannot be determined precisely by checking the outer appearance of the container. The aim of this study was to determine and improve home-care patients' adherence to topical efinaconazole treatment regimens by measuring amounts remaining in the containers using a portable electronic scale. We found that this method is useful for determining the status of topical efinaconazole use.

[Paradigm Shift in the Quality of Regional Medical Care: Cooperative Treatment of Onychomycosis].

　In a superaging society, the medical paradigm should include both less coverage of medical-care work flow by human resources and high-quality care for patients. Strategies such as establishing medical-care teams and community medicine systems mainly for home medical care should be implemented. However, a well-organized system for home-based medical treatment of elderly patients is not yet in place, as evidenced by the lack of care, problems with long-term polypharmacy resulting from visits to multiple healthcare providers, and declines in their physical strength. It is assumed that care might not be provided in association with treatment because planning based on the paradigm of "home medical care" has not been fully established. Therefore, in this study, we aimed to determine the "paradigm shift in home medical care" based on the treatment of onychomycosis. We also hoped to identify the types of medical support required to improve the general well-being of individuals and what needs to be done to ensure a high quality of life for patients. All those (including patients themselves) involved in patient care should together formulate a protocol for medical treatment and cooperate based on the role each can play. Although it may be difficult to maintain cooperation among healthcare workers, improvements in the medical quality of an entire region can be achieved by planning a life design including medical treatment for each patient.