Purpose: Onychomycosis is a nail disorder that is increasing in prevalence worldwide. The psychological and social limitations caused by onychomycosis can potentially undermine the work and social lives of those experiencing these negative effects. This review aimed to evaluate the randomized controlled trials (RCTs) available in the current literature on the impact onychomycosis has on quality of life (QoL). Methods: A systematic review was performed using the databases PubMed, PsycINFO, Scopus, ClinicalTrials.gov, and Cochrane Library on July 18, 2017. Only RCTs with clinical effects described in English were included for review. Results: Ten RCTs reported QoL outcomes for patients suffering from onychomycosis. Treatment satisfaction was statistically significant from baseline to end of treatment in 100.0% (4/4) measures which reported on satisfaction with treatment; mental health was also significant in 100.0% (3/3), symptoms index rating in 100.0% (2/2), symptom frequency in 75.0% (3/4), overall problems in 75.0% (3/4), functional activities in 75.0% (6/8), appearance problems in 66.7% (2/3), symptom distress in 57.1% (4/7), and stigma in 40.0% (2/5). The OnyCOE-tTM and the NailQoL were the most used common outcome measures to describe QoL. Conclusion: The study sanctions that onychomycosis physically and psychologically distresses patients’ lives. Further research should include validated outcome measures to more effectively treat onychomycosis.

Keywords:
Quality of life, Onychomycosis
1.
Gupta AK, Jain HC, Lynde CW, MacDonald P, Cooper EA, Summerbell RC: Prevalence and epidemiology of onychomycosis in patients visiting physicians’ offices: a multicenter Canadian survey of 15,000 patients. J Am Acad Dermatol 2000; 43: 244–248.
2.
Abdullah L, Abbas O: Common nail changes and disorders in older people. Can Fam Physician 2011; 57: 173–181.
3.
Elewski BE, Tosti A: Risk factors and comorbidities for onychomycosis. J Clin Aesthet Dermatol 2015; 8: 38–42.
4.
Sigurgeirsson B, Steingrímsson O: Risk factors associated with onychomycosis. J Eur Acad Dermatol Venereol 2004; 18: 48–51.
5.
Tosti A, Hay R, Arenas-Guzmán R: Patients at risk of onychomycosis – risk factor identification and active prevention. J Eur Acad Dermatol Venereol 2005; 19(suppl 1): 13–16.
6.
Lateur N: Onychomycosis: beyond cosmetic distress. J Cosmet Dermatol 2006; 5: 171–177.
7.
Warshaw EM, Foster JK, Cham PMH, Grill JP, Chen SC: NailQoL: a quality-of-life instrument for onychomycosis. Int J Dermatol 2007; 46: 1279–1286.
8.
Turner RR, Testa MA: Measuring the impact of onychomycosis on patient quality of life. Qual Life Res 2000; 9: 39–53.
9.
Malay DS, Yi S, Borowsky P, Downey MS, Mlodzienski AJ: Efficacy of debridement alone versus debridement combined with topical antifungal nail lacquer for the treatment of pedal onychomycosis: a randomized, controlled trial. J Foot Ankle Surg 2009; 48: 294–308.
10.
Potter LP, Mathias SD, Raut M, Kianifard F, Landsman A, Tavakkol A: The impact of aggressive debridement used as an adjunct therapy with terbinafine on perceptions of patients undergoing treatment for toenail onychomycosis. J Dermatol Treat 2007; 18: 46–52.
11.
Potter LP, Mathias SD, Raut M, Kianifard F, Tavakkol A: The OnyCOE-t questionnaire: responsiveness and clinical meaningfulness of a patient-reported outcomes questionnaire for toenail onychomycosis. Health Qual Life Outcomes 2006; 4: 50.
12.
Ling MR, Swinyer LJ, Jarratt MT, Falo L, Monroe EW, Tharp M, Kalivas J, Weinstein GD, Asarch RG, Drake L, Martin AG, Leyden JJ, Cook J, Pariser DM, Pariser R, Thiers BH, Lebwohl MG, Babel D, Stewart DM, Eaglstein WH, Falanga V, Katz HI, Bergfeld WF, Hanifin JM, Young MR, et al: Once-weekly flu-conazole (450 mg) for 4, 6, or 9 months of treatment for distal subungual onychomycosis of the toenail. J Am Acad Dermatol 1998; 38:S95–S102.
13.
Ortiz AE, Truong S, Serowka K, Kelly KM: A 1,320-nm Nd:YAG laser for improving the appearance of onychomycosis. Dermatol Surg 2014; 40: 1356–1360.
14.
Gilaberte Y, Robres M, Frias MP, Garcia-Doval I, Rezusta A, Aspiroz C: Methyl aminolevulinate photodynamic therapy for onychomycosis: a multicentre, randomized, controlled clinical trial. J Eur Acad Dermatol Venereol 2017; 31: 347–354.
15.
Friedlander SF, Chan YC, Chan YH, Eichenfield LF: Onychomycosis does not always require systemic treatment for cure: a trial using topical therapy. Pediatr Dermatol 2013; 30: 316–322.
16.
Tosti A, Elewski BE: Treatment of onychomycosis with efinaconazole 10% topical solution and quality of life. J Clin Aesthet Dermatol 2014; 7: 25–30.
17.
Friedlander SF: A 9-year-old boy with mild distal-lateral subungual onychomycosis. Adv Stud Med 2005; 5:S624–S628.
18.
Lubeck DP: Measuring health-related quality of life in onychomycosis. J Am Acad Dermatol 1998; 38:S64–S68.
19.
Drake LA: Impact of onychomycosis on quality of life. J Am Podiatr Med Assoc 1997; 87: 507–511.
20.
Zienicke HC, Korting HC, Lukacs A, Braun-Falco O: Dermatophytosis in children and adolescents: epidemiological, clinical, and microbiological aspects changing with age. J Dermatol 1991; 18: 438–446.
21.
Elewski BE: Onychomycosis. Treatment, quality of life, and economic issues. Am J Clin Dermatol 2000; 1: 19–26.
22.
Drake LA, Patrick DL, Fleckman P, Andr J, Baran R, Haneke E, Sapède C, Tosti A: The impact of onychomycosis on quality of life: development of an international onychomycosis-specific questionnaire to measure patient quality of life. J Am Acad Dermatol 1999; 41: 189–196.
23.
Lubeck DP, Patrick DL, McNulty P, Fifer SK, Birnbaum J: Quality of life of persons with onychomycosis. Qual Life Res 1993; 2: 341–348.
24.
Lubeck DP, Gause D, Schein JR, Prebil LE, Potter LP: A health-related quality of life measure for use in patients with onychomycosis: a validation study. Qual Life Res 1999; 8: 121–129.
25.
Rich P: Special patient populations: onychomycosis in the diabetic patient. J Am Acad Dermatol 1996; 35:S10–S12.
26.
Findley K, Oh J, Yang J, Conlan S, Deming C, Meyer JA, Schoenfeld D, Nomicos E, Park M; NIH Intramural Sequencing Center Comparative Sequencing Program, Kong HH, Segre JA: Topographic diversity of fungal and bacterial communities in human skin. Nature 2013; 498: 367–370.
27.
Hair & Nail Salons – Canada Market Research Report. IBISWorld. https://www.ibisworld.ca/industry/hair-nail-salons.html (accessed August 2, 2017).
28.
Scher RK: Onychomycosis is more than a cosmetic problem. Br J Dermatol 1994; 130(suppl 43): 15.
29.
Gupta AK, Jain HC, Lynde CW, Watteel GN, Summerbell RC: Prevalence and epidemiology of unsuspected onychomycosis in patients visiting dermatologists’ offices in Ontario, Canada – a multicenter survey of 2001 patients. Int J Dermatol 1997; 36: 783–787.
30.
Chacon A, Franca K, Fernandez A, Nouri K: Psychosocial impact of onychomycosis: a review. Int J Dermatol 2013; 52: 1300–1307.
31.
Reich A, Szepietowski JC: Health-related quality of life in patients with nail disorders. Am J Clin Dermatol 2011; 12: 313–320.
32.
Shuster S: Depression of self-image by skin disease. Acta Derm Venereol Suppl (Stockh) 1991; 156: 53.
33.
Szepietowski JC, Reich A; National Quality of Life in Dermatology Group. Stigmatisation in onychomycosis patients: a population-based study. Mycoses 2009; 52: 343–349.
34.
Shaw JW, Joish VN, Coons SJ: Onychomycosis: health-related quality of life considerations. Pharmacoeconomics 2002; 20: 23–36.
35.
Helplessness as Predictor of Perceived Stigmatization in Patients with Psoriasis and Atopic Dermatitis. ResearchGate. https://www.researchgate.net/publication/244914407_Helplessness_as_Predictor_of_Perceived_Stigmatization_in_Patients_with_Psoriasis_and_Atopic_Dermatitis (accessed August 7, 2017).
36.
Drake L: Quality of life issues for patients with fungal nail infections. AIDS Patient Care 1995; 9(suppl 1):S15–S17.
37.
Roberts DT: Prevalence of dermatophyte onychomycosis in the United Kingdom: results of an omnibus survey. Br J Dermatol 1992; 126(suppl 39): 23–27.
38.
Levy L: Epidemiology of onychomycosis in special-risk populations. J Am Podiatr Med Assoc 1997; 87: 546–560.
39.
Gregory N: Special patient populations: onychomycosis in the HIV-positive patient. J Am Acad Dermatol 1996; 35:S13–S16.
40.
Szepietowski JC, Reich A, Pacan P, Garlowska E, Baran E; Polish Onychomycosis Study Group: Evaluation of quality of life in patients with toenail onychomycosis by Polish version of an international onychomycosis-specific questionnaire. J Eur Acad Dermatol Venereol 2007; 21: 491–496.
41.
Milobratović D, Janković S, Vukičević J, Marinković J, Janković J, Railić Z: Quality of life in patients with toenail onychomycosis. Mycoses 2013; 56: 543–551.
42.
Belyayeva E, Gregoriou S, Chalikias J, Kontochristopoulos G, Koumantaki E, Makris M, Koti I, Katoulis A, Katsambas A, Rigopoulos D: The impact of nail disorders on quality of life. Eur J Dermatol 2013; 23: 366–371.
43.
Gupta MA, Gupta AK, Johnson AM: Cutaneous body image: empirical validation of a dermatologic construct. J Invest Dermatol 2004; 123: 405–406.
44.
Tabolli S, Alessandroni L, Gaido J, Sampogna F, Di Pietro C, Abeni D: Health-related quality of life and nail disorders. Acta Derm Venereol 2007; 87: 255–259.
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