Épidémiologie et prise en charge des onychomycoses en pratique dermatologique libérale en France

Abstract

Increasing prevalence of onychomycosis has been observed in recent years and regular epidemiological studies of the disease are thus necessary. In addition, treatment of onychomycosis by private dermatologists needs to be better understood. This study was carried out to improve knowledge about the epidemiology of onychomycosis and its management in private practice in France. Four hundred and eighty-five private dermatologists practising throughout France took part in the study. Between September 2001 and December 2002, they collected the following data for each patient with clinically diagnosed onychomycosis: age, gender, concomitant diseases, regular practice of sport, clinical type of onychomycosis, mycological sampling and results, treatment type, monotherapy or combined therapy. Forty-seven percent of patients (i.e. 1826) underwent mycological sampling. In 1200 cases, a fungus was identified. The results for these 1200 patients were as follows: 44% of patients had matrix involvement. Associated diseases were: diabetes (5%), psoriasis (4.5%), immunosuppression (1%) and peripheral vasculopathy (5%). Onychomycosis involved the toes in 88.7% of cases, the fingers in 8.7% and both toes and nails in 2.6%. In the toes, the clinical diagnosis was subungual distal onychomycosis in 74.2% of cases, superficial leuconychia in 11.1%, proximal subungual onychomycosis in 3.3%, and total onychomycodystrophy in 11.4%. In the toes, a dermatophyte was isolated in 84% of cases, yeast in 8% and a mould in 6%. In the fingers, a dermatophyte was isolated in 37% of cases, yeast in 55% and a mould in 8%. Monotherapy was prescribed to 35% of patients and combined therapy in 65%. Oral treatment represented 59% of monotherapies. The main results of our study are that dermatologists do not perform any mycological sampling before treating onychomycosis in 53% of cases; in 56% of cases, onychomycosis does not involve the nail matrix; onychomycosis is localized in the toes 10 times more often than in the fingers; the distal subungual clinical form represents more than 70% of cases, in fingers and toes; in the toes, the total onychomycodystrophy clinical form represents 11.4% of cases; dermatologists prescribe monotherapy in 35% of cases, with 59% of these monotherapies comprising an oral treatment, while matrix involvement is present in only 44% of cases. Continual medical education efforts must be continued concerning onychomycosis diagnosis and management in accordance with the French Dermatological Society recommendations.