Prognostic factors influencing the treatment outcome of onychomycosis Candida

Abstract

Onychomycosis contributes as many as half of all nail disorder cases. In 2017, the incidence of onychomycosis was 15% of all dermatomycosis cases at our hospital, a tertiary hospital in Indonesia, with only 25% of the patients achieving mycological cure. This study aims to identify the prognostic factors influencing the treatment outcome of onychomycosis Candida. This is a retrospective study, using data obtained from outpatient registry at our hospital. Fifty-four onychomycosis patients were included in this study. Potential prognostic factors were analysed by STATA15.0. Retrospective analysis with cox proportional-hazard was used to measure the contribution of each variable to the treatment's outcome. Onset of disease, history of nail disorder, and site of infection were not associated with mycological cure (P>.05). Based on retrospective analysis, age[odds ratio (OR)1.46; 95% confidence interval (CI)1.07-2.03], onset of disease (OR 1.14; 95%CI 1.11-1.17), comorbidities (OR 1.07; 95%CI 1.03-1.11), type of onychomycosis (OR 1.08; 95%CI 1.05-1.16), site of infection (OR 1.12; 95%CI 1.04-1.22) and number of infected nails (OR 1.50; 95%CI 1.25-1.68) were significantly associated with poor treatment outcome, while type of treatment and type of systemic agents showed no significant association with the outcome. Kaplan-Meier curves showed that subjects elderly age and more than 3 infected nails had the lowest median survival. Elderly, longer onset, presence of comorbidities, multiple sites of infection, and high number of infected nails can affect the mycological cure negatively. Unstandardised treatment was associated with the mycological cure despite not affecting the prognosis. Therefore, the management's goal is to identify these specific prognostic features.