Onychomycosis: health-related quality of life considerations.
ABSTRACT The symptoms of onychomycosis and their impact on personal appearance are important determinants of patients' perceptions of their own health. The effect of onychomycosis is greater on psychosocial than physical functioning and is directly related to the extent of nail involvement. This review identified a number of disease-targeted questionnaires that have been developed to assess the impact of onychomycosis and its treatment on health-related quality of life (HR-QOL). The instruments differ considerably in the extent to which they have been psychometrically tested. Most have been shown to provide both valid and reliable measurement of HR-QOL in patients with onychomycosis of the toes. However, not all have been tested in patients with fingernail disease. The generic and disease-targeted scales of most of the available questionnaires exhibit poor variability, which may limit their responsiveness to clinically important change. Only one instrument, the Onychomycosis Disease-Specific Questionnaire, has been incorporated into a clinical trial. Thus, information relating to the impact of onychomycosis treatment on HR-QOL is limited. Future efforts should focus on the systematic evaluation of existing questionnaires in all populations for which they were developed. In addition, it is important that disease-targeted measures be included in future clinical trials so that a better understanding of the impact of onychomycosis treatment on patient HR-QOL may be gained.
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ABSTRACT: Entre 1990 y 2000, en el laboratorio de micología médica de la Universidad de Antioquia (Medellín, Colombia), se atendieron 4621 pacientes con lesiones ungueales; para el diagnóstico se usaron examen directo y cultivo de la muestra ungueal. Este informe sólo incluye 310 pacientes que cumplieron el siguiente cri-terio diagnóstico: crecimiento del mismo hongo no dermatofítico en cinco o más sitios de siembra. De 310 cultivos positivos, 284 tuvieron examen directo positi-vo, si bien no se observó una estructura morfológica típica de ningún género. Hasta 1989, la incidencia media encontrada en nuestro laboratorio era de 9 casos/año, aumentando a 28 casos/año (211%) en 1990-2000. Los géneros hallados fueron Fusarium en 50%, Nattrassia (Scytalidium dimidiatum) 31%, Aspergillus y Dendrophoma 7% cada uno, Penicillium y Scopulariopsis 2% cada uno y Acremonium menos de 1%. La prevalencia general de onicomicosis por hongos no dermatofíticos se calcula en 12,4% en 1990-2000. Se describen las características epidemiológicas, se comparan con lo publicadopor otros autores y se define el perfil básico del paciente afectado: hombre adulto (31-40 años) que usa calzado de riesgo y practica deporte, lo que lo predispone a hiperhidro-sis en pies, favoreciendo la onicomicosis, con evolución promedio de 30 meses en ambos sexos. El porcentaje de pacientes con onicomicosis fue mayor en las mujeres que en los hombres, 62% y 38% respectivamente. Onicomicosis, Fusarium, Nattrassia, Hongos no dermatofíticos, Perfiles epidemiológicos Onychomycosis by common non-dermatophyte moulds Between 1990 and 2000, The Medical Mycology Laboratory at University of Antioquia (Medellín, Colombia), attended 4621 patients, with nail dystrophies. We used the direct test and culture of nail samples for diagnostic purposes. This report includes 310 patients, 7% (310/4621), with positive cultures for the same non-dermathophyte fungi, in five or more places of inoculation. From the 310 positive cultures, 284 (92%) were positive in direct test. No characteristic morp-hology for any of the genera could be detected. Until 1989 we had an average of 9 cases per year and between 1990 and 2000 we found 28 cases per year (an increase of 211%). The implicated genera were: Fusarium 50%, Nattrassia 31%, Aspergillus and Dendrophoma 7% each, Penicillium and Scopulariopsis contribu-ted with 2 % each, and Acremonium was found in less of 1% of cases. The general prevalence of onychomycosis due to non-dermatophytic fungi was about 12,4% between 1990 – 2000. This report describes the main epidemiological characteristics found, comparing them with results from other authors, and defi-nes the basic profile of affected patients: adults (31-40 years old) who use occlu-sive shoes (trainers) and practice sport, which predispose to hyperhydrosis and consequently to onychomycosis. The course of the disease takes in average 30 months in both sexes. The percentage of onychomycosis found was 62% for women and 38% for men.
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ABSTRACT: Health-related quality of life (HRQoL) measurements in clinical practice ensure that treatment and evaluations focus on the patient rather than the disease. To verify whether these measurements are also relevant in a minor dermatological disease and whether a generic routine assessment is sufficient to capture different aspects of quality of life, we studied patients affected by nail disorders. The Skindex-29, the 12-item General Health Questionnaire and the 36-item Short Form of the Medical Outcomes Study questionnaires were used. A total of 114 patients were enrolled: 31% men aged 48 +/- 15 years and 69% women aged 49 +/- 14 years (mean +/- SD). The mean values of SF-36 scales in nail disorders were higher than those reported for minor skin diseases, and Skindex-29 values were lower. A duration of disease > or =1 year was associated with higher Skindex-29 scores on the symptom and emotions scales. Patients with onychomycosis have higher values on the Skindex-29 social functioning scale compared with other nail disorders. The use of HRQoL measurements in routine clinical activities allows us to depict how nail disorders affect patients and show how relevant some neglected aspects, such as pain or emotional trauma, are and offers us the opportunity to address these issues in a patient-centred approach to treatment.Acta Dermato Venereologica 01/2007; 87(3):255-9. · 3.18 Impact Factor