Onychomycosis: more than nail changes

J. Szepietowski

Author address: 

University of Medicine and Polish Academy of Sciences, Wroclaw, Poland


Onychomycosis is the most frequent nail disease. It accounts for about 50% of all nail changes and for about 30% of all cutaneous fungal infections. Prevalence of onychomycosis in highly developed countries is assessed to be 3% to 8% depending on the available studies. Toenail onychomycosis is 4 to 7 times more frequent than fingernail disease. Onychomycosis is not a life-threatening disease, however, it cannot be considered as a cosmetic problem. The majority of patients with onychomycosis suffer from long lasting disease, despite appropriate antifungal therapy is introduced. Furthermore, it was clearly shown that infected toenails are risk factor for the development of bacterial cellulitis of lower legs or may be a reservoir of pathogens, from which the infection spreads onto other skin areas. On rare occasions it could even disseminate via blood resulting in sepsis and patient’s death. About 70% of toenail onychomycosis patients considered their nail disease to be at least as moderate problem for them. Comparison with healthy people, gender- and age-matched, showed that subjects with onychomycosis had significantly poorer ratings of general health perception, bodily pain, mental health, social functioning, proportion of physical appearance and functional limitations. In a study by our group more than 20% of patients had severely decreased, 30% had moderately altered and about one third had slightly impaired quality of life (QoL), while only 14.9% of patients revealed normal health-related QoL. Comparing to other chronic dermatoses, onychomycosis impaired QoL less than atopic dermatitis or psoriasis, nearly as much as seborrheic dermatitis and non-melanoma skin cancers, and to much greater extend than androgenic alopecia. Improvement of QoL level is strictly connected with improvement or cure of infected nails. In consequence, patients satisfied from the treatment had better QoL. However, reoccurrence of the disease resulted in decrease of QoL to greater extend compared to patients who had the disease for the first time and were not previously treated due to onychomycosis. In conclusion, based on our own experience and literature data we state that onychomycosis causes significant stigmatization and decrease of QoL in the majority of patients.

abstract No: 


Full conference title: 

4th Trends in Medical Mycology
    • TIMM 4th (2012)