Epidemiology Of Onychomycosis Research Articles

Prevalence of onychomycosis in patients with diabetes mellitus: A cross-sectional study from a tertiary care hospital in North India.

Background Though diabetes mellitus (DM) is a well-recognised risk factor for onychomycosis (OM), the epidemiology of OM in diabetic patients remains largely unexplored, especially from the Indian subcontinent. Aims and objectives To estimate the prevalence of OM in diabetic patients, to identify and analyse risk factors, and correlate the severity of nail changes with glycemic control (HBA1c). Methods This cross-sectional, analytical study involved 300 diabetic patients. Patients with the clinical diagnosis of OM, supplanted by at least two of the four tests (KOH, culture, onychoscopy and nail histopathology) were considered cases of OM. Demographic and haematological profile was analysed using chi-square test/ Fischer's exact test. Logistic regression was applied to assess the independent risk factors. Results The prevalence of OM in DM patients was 34% (102/300) and significant risk factors included; age >60 years, male gender, closed shoes, disease duration >5 years, high BMI (>25) and lack of awareness about nail changes. Distal and lateral subungual OM (78%) was the commonest presentation followed by proximal subungual OM, superficial OM and total dystrophic OM. Correlation between HbA1c and the number of nails involved was found to be significant. Limitation As cases were recruited from a hospital setting, there could be chances of Berksonian bias. Conclusion The prevalence of OM in diabetic patients is high and the severity of nail changes correlates with HbA1C levels. It is important to diagnose OM early in order to treat and prevent complications.

Epidemiology of Onychomycosis in Pernambuco, Northeastern of Brazil: Results of a Laboratory-Based Survey

Epidemiology of Onychomycosis in Pernambuco, Northeastern of Brazil: Results of a Laboratory-Based Survey

Subclinical Onychomycosis: Not Present in HIV-Positive Population?

Background: Onychomycosis is one of the most common nail diseases and constitutes up to 50% of all nail conditions. It is a chronic fungal nail infection common in the HIV-infected population. Few studies have found fungal organisms in the nail without clinical evidence, and thus, termed subclinical onychomycosis. Objectives: We analyzed the nails of the HIV population in our hospital, searching for subclinical onychomycosis. Method: A distal nail clipping was stained with PAS and observed by a trained dermatopathologist. Results: All of our samples (n = 48) turned out to be negative for fungal structures. Conclusions: The epidemiology of onychomycosis is changing, treatment options are much better now, and diagnosis and infection detection are being done earlier. Therefore, we will continue to further study this disease in other patient populations so that we can compare our results and see whether the incidence of onychomycosis in the HIV population is now similar to that in those without HIV infection of the same age.

Study of various clinical and microbiological patterns of onychomycosis in western Rajasthan

Background:-Onychomycosis is invasion of nail plate by fungus, caused by both dermatophytes & non-dermatophytes. In this study, the main aims & objectives are identification of various clinical forms, microbiological agents & epidemiology of onychomycosis as well as its association with various dermatological conditions & systemic diseases in western Rajasthan.
 Materials and Methods:-The study involved a total of 150 cases of onychomycosis which was suspected on clinical basis. Subsequently KOH examination & culture was done for identification of microbiological agents causing the disease. Patients were also looked for other skin & systemic diseases.
 Results:-In our study, the incidence of onychomycosis was 1.8%. It occurs more commonly in men between age group of 20-50 years, accounting for 80% of total cases. Housewives, office workers, farmers & cattle workers were more commonly affected. Distal & lateral subungual onychomycosis (DLSO) was seen in 85.33% cases. Toenails & fingernails were affected in 55.9% & 34.6% cases, respectively. KOH was positive in 48.6% cases. Culture showed growth in 37.3% cases. Trichophyton rubram was the most common etiological agent. Associated Keratoderma, asteotic eczema, psoriasis & raised blood sugar was seen in 5%, 2.5%, 2.5% & 6.66% cases, respectively.
 Conclusion:-The present study concluded that onychomycosis has an incidence of 1.8% & occurs mainly in age group of 30-40 years of housewives, office workers, farmers & cattle workers. DLSO was most common clinical type affecting toenails more commonly than fingernails & T.rubram was the most common etiological agent.

Epidemiology of onychomycosis in Serbia: a laboratory-based survey and risk factor identification.

Onychomycosis is a fungal infection of the fingernails and/or toenails caused by dermatophytes, yeasts and non-dermatophyte moulds. The epidemiology of onychomycosis in Serbia is yet to be fully established. This epidemiological study was aimed at evaluating the epidemiology of onychomycosis in a sample of the Serbian patients at risk of onychomycosis, to determine the fungal aetiological agents and to identify the possible risk factors. The study population included 374 patients from six centres in Serbia with suspected onychomycosis. Demographic data, data about comorbidities, lifestyle, clinical aspects of onychomycosis, trauma, excessive perspiration and personal and family history of previous onychomycosis were studied. Laboratory confirmation of diagnosis was done by direct microscopy, fungal culture and PCR. Diagnosis of onychomycosis was confirmed in 50.8% of patients, who tested positive to at least one laboratory test (direct microscopy, fungal culture or PCR). Trichophyton rubrum was predominant both on toenails (85.98%) and on fingernails (38.46%). Independent risk factors for onychomycosis were: old age (OR = 2.285; P < 0.001), family history of previous onychomycosis and/or tinea pedis (OR = 2.452; P = 0.005), excessive perspiration (OR = 2.165; P = 0.002) and higher degree of hyperkeratosis (OR = 1.755; P = 0.020). This is a first epidemiological study of onychomycosis from Serbia.

Epidemiology of onychomycosis in Italy: prevalence data and risk factor identification.

The prevalence of onychomycosis differs according to geographic area and over time and is influenced by several factors. The epidemiology of onychomycosis in Italy is still unclear. To evaluate the prevalence of onychomycosis in a representative sample of the Italian population a group of Dermatologists and General Practitioners carried out an observational survey on the patients coming to their office during a 1-month period. Any patient with skin or systemic disease giving their consent was enrolled. Demographic characteristics, comorbidities, lifestyles, history of previous mycosis, clinical aspects of onychomycosis and mycological evaluation were studied. A total of 8331 patients (56.7% female and 43.3% male) were evaluated. More than half of them were aged ≥46 years. Onychomycosis was diagnosed in 14.2% of patients. Big toe and thumb were the most frequently affected nails. Onychomycosis was moderate-severe in 74.1% of the cases. Mycological tests were positive in 81.3% of the cases. Dermatophytes were found in 76.6% of the cases, yeasts in 17.2% and moulds in 6.3%. Risk factors and/or comorbidities were present in 68.2% of the cases. This survey showed a 14% prevalence of onychomycosis in the evaluated population. The main risk factors were previous onychomycosis, diabetes, hallux valgus and use of occlusive footwear.

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

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.

Epidemiology of onychomycosis in central Poland

Epidemiology of onychomycosis in central Poland

Epidemiology of Onychomycosis in Indonesia: Data Obtained from Three Individual Studies

In terms of both diagnosis and treatment, onychomycosis remains a problem in Indonesia. To examine this situation, we performed a retrospective study of the incidence of onychomycosis involving 10 state university hospitals across the country. We collected data from medical records of patients treated at these hospitals in 1997-1998 (study 1) and from a 1998-1999 multi-center Indonesian study on pulse-dose itraconazole therapy (study 2), both of which were part of onychomycosis campaigns with the objective of increasing the awareness of physicians of onychomycotic problems. Further, we analyzed data from year 2003 medical records of patients from 4 hospitals in Java (study 3). The average incidence of onychomycosis among fungal diseases increased to 4.7% in large cities that, from an average incidence within Indonesia of 3.5% in 1997-1998. At only 0.5%, the incidence of onychomycosis among all skin diseases was low in both study 1 and 3. Female patients outnumbered male patients with a ratio of 1.5:1 to 2:1. In study 2, the fingernail was the site most frequently affected. KOH examinations and fungal culture in study 1 (n=557) showed causative organisms to be Candida (50.1%), dermatophytes (26.2%), moulds (3.1%) and mixed infections (1.8%), with the remainder (18.7%) unidentified. Similar frequency of causative organisms was reported in study 2 (n=113) and in study 3 (n=183). People's low awareness of nail disease and consequent lack of concern as well as the limited diagnostic ability of KOH examination and fungal culture might influence the low incidence of the disease and the frequency of detection of the causative organisms.

Epidemiology of onychomycosis and paronychia in the area of ANCONA (ITALY) over a period of 5 years

We retrospectively evaluated the epidemiology of onychomycosis and/or paronychia in 172 patients attending the Clinic of Dermatology and Venereology over a 5 year period. Although yeast isolates, belonging to the Candida species, represented the most frequent etiologic agents of these infections, an increasing prevalence of fungal infections due to emerging fungal pathogens (EFP) was noted throughout this time period. In particular, EFP as causative agents of these infections increased from 0 to 28.4% from 1998 to 2002.

Prevalence and epidemiology of onychomycosis in patients visiting physicians’ offices: a multicenter Canadian survey of 35,000 patients

Prevalence and epidemiology of onychomycosis in patients visiting physicians’ offices: a multicenter Canadian survey of 35,000 patients

Evaluation of the drug treatment and persistence of onychomycosis.

Onychomycosis is a common nail disease responsible for approximately 50% of diseases of the nail. It occurs more in the elderly, though several cases have been reported among children. Several factors influence, such as climate, geography, and migration. The two dermatophytes most commonly implicated in onychomycosis are Trichophyton rubrum and T. mentagrophytes, accounting for more than 90% of onychomycoses. Nonetheless, several other toxigenic molds have been implicated. For convenience, onychomycosis is divided into four major clinical presentations: distal subungal, which is the most common form of the disease; proximal subungal, which is the most common form found in patients with human immunodeficiency virus infection; superficial; and total dystrophic onychomycosis. Epidemiology of onychomycosis in adults and children is evaluated and the most common clinical symptoms addressed. Although the risk factors are discussed, the multifactorial nature of onychomycosis makes this inexhaustible. The diagnosis and treatments are difficult and the choice of appropriate antifungal drugs complex and require the knowledge of the chemical structures of the metabolites of the molds that cause onychomycosis and their interaction with the antifungal drugs. This is true because most of the antifungal drugs are derived from mold/fungal metabolism. Treatment with griseofulvin and amphotericin is displaced by the use of newer drugs from azole compounds, pyrimidines, and allylamines derivatives. Amorolfine, itraconazole, and ciclopirox nail lacquer solution 8 have gained support globally, but the side effects, drug resistance, and persistence of the disease are still a serious concern to the patients, just as economics and quality of life. Hence, the search for safer and more efficacious drug treatments are continuing.

Which antifungal agent for onychomycosis? A pharmacoeconomic analysis.

The incidence of fungal nail infections is increasing and this is possibly because of several factors: better methods of detection, a growing population of immunocompromised patients who have a greater susceptibility to such infections, the increased use of immunosuppressive drugs, the increasing number of elderly people, worldwide travel, and the use of communal bathing facilities. Onychomycosis is a fungal infection of the fingernails and toenails that accounts for about 30% of all superficial fungal infections. It is characterised by nail discoloration, thickening and ultimately destruction of the nail plate. Management of this disease has improved significantly and treatment patterns have dramatically changed in recent years as a result of advances in new treatment options (e.g. oral antifungal agents) and changes in treatment regimens (e.g. pulse therapy). Also, newer drugs for onychomycosis have improved tolerability profiles compared with older agents. The overall costs of treating onychomycosis are substantial, and it has been estimated that direct cost for US Medicare patients with the disease is 43 million US dollars per year (year of costing not available). Pharmacoeconomic studies help in the decision-making process when selecting the most cost-effective antifungal agents to treat onychomycosis. To date there have been a number of national and international economic studies aimed at effectively assessing the efficacy and costs of the treatment options available to cure onychomycosis. The objectives of this paper are to (i) review the published findings regarding the epidemiology of onychomycosis; (ii) summarise the original pharmacoeconomic studies that describe the economic impact of the disease; and (iii) address the impact of the disease on patients' health-related quality of life.

The epidemiology of onychomycosis: possible role of smoking and peripheral arterial disease.

Onychomycosis is a relatively common condition the aetiology of which appears to be multifactorial, with both genetic and acquired factors being responsible. In our clinical practice we have observed that smokers and individuals with peripheral arterial disease may have an increased prevalence of onychomycosis compared to normal individuals. Patients attending a vascular clinic in a hospital were asked about a history of smoking and peripheral arterial disease. The lower extremity was assessed for peripheral arterial disease. Material was obtained from toenails for mycological evaluation. Two hundred and fifty-four patients (male 146, female 108; age, mean +/- standard error, 66.6 +/- 0.8 years) were enrolled. Abnormal-appearing nails and onychomycosis were present in 49.2% and 22.4% of patients, respectively. Factors associated with onychomycosis included, increasing age (risk odds ratio [ROR] 1.05, P = 0.002), male gender (ROR 1.7, P = 0.09), smoking (packs per day) (ROR 1.9, P = 0.02) and peripheral arterial disease (ROR 4.8, P = 0.02). The factors predisposing to the development of onychomycosis are multifactorial. Both smoking (number of packs of cigarettes consumed per day) and peripheral arterial disease are independent predictors of onychomycosis. Awareness of these factors may help in the prevention of onychomycosis and the optimal management of this disease.