Effect of onychomycosis and treatment on patient-reported quality-of-life outcomes: A systematic review - 08/08/20

Doi : 10.1016/j.jaad.2020.05.143

Claire R. Stewart, BA ^a, Leah Algu, BS ^b, Rakhshan Kamran, BS ^c, Cameron F. Leveille, MD ^d, Khizar Abid, BS ^b, Charlene Rae, MSc ^e, Shari R. Lipner, MD, PhD ^f,^⁎
^a Weill Cornell Medical College, New York, New York
^b Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
^c Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
^d Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
^e Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
^f Department of Dermatology, Weill Cornell Medicine, New York, New York

^∗Correspondence to: Shari R. Lipner, MD, PhD, Department of Dermatology, Weill Cornell Medicine, 1305 York Ave, 9th Floor, New York, NY 10021.Department of DermatologyWeill Cornell Medicine1305 York Ave, 9th FloorNew YorkNY10021

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Abstract

Background

Onychomycosis is the most common nail disorder, often causing physical, emotional, and aesthetic consequences. The effect of both the condition itself and treatment on quality of life has not been well studied.

Objective

The objectives of this study were to systematically review the available literature describing the effect of onychomycosis and treatment on quality of life.

Methods

We performed a search of the onychomycosis literature published before April 13, 2020. Articles were included in the review if primary data were presented, patient-reported outcome measures were used, and onychomycosis was specifically examined.

Results

Thirty studies were included in the final analysis. Poorest quality-of-life scores were associated with women and fingernail involvement. Quality-of-life scores improved from baseline with all treatment types; there were greater improvements reported with oral treatments compared with topical ones.

Conclusions

This review affirms that onychomycosis significantly influences quality of life, warranting effective treatment. All treatments resulted in quality-of-life improvements; however, studies on oral and topical therapies were of higher quality than those evaluating devices. Increased efforts are needed to understand the effect of the disease and therapy as assessed by validated, nail-specific outcome measures that accurately assess patients' cosmetic, physical, and social difficulties.

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Key words : amorolfine, ciclopirox, debridement, efinaconazole, itraconazole, laser therapy, nail fungus, onychomycosis, patient-reported outcome measures, photodynamic therapy, quality of life, terbinafine, topical therapy