“…Regarding the toenail anatomical area affected by onychomycosis, our results are in consonance with a recent review carried out in 2022, the first toenail being the most affected area [ 6 ].…”
Section: Discussionsupporting
confidence: 92%
“…With regard to clinical presentation, TDO and MO are the most common among the housed population and among the homeless population DSO and MO. Notwithstanding that fact, we have not found any recent studies that match the clinical presentations of our research since most studies describe that the most frequent clinical presentation is DLSO [ 6 , 21 , 22 ]. This could be explained by our sample size.…”
Section: Discussionmentioning
confidence: 54%
“…The first toenail is the most frequently affected one [ 5 , 6 ]. Changing lifestyles, advanced age, obesity and immunosuppressed states such as diabetes mellitus, organ transplantation, corticosteroid use and antineoplastic drugs are increasing the prevalence of yeast and non-dermatophyte fungal infections [ 5 , 7 ].…”
Onychomycosis is one of the most common foot conditions. Mixed onychomycosis and onychomycosis caused by non-dermatophyte moulds are increasing in incidence, especially in vulnerable populations, hence the importance of this study, which presents the prevalence of onychomycosis in a population of homeless people, comparing the findings with a sample of a well-resourced population. The total sample consisted of 70 participants, divided into two separate groups, a homeless population and a second group in which we included people attending a private clinic. The average age of the sample is [49.19 ± 28.81] with an age range of 18 to 78 years). In the homeless group, the most prevalent infectious agents were non-dermatophyte fungi, with a total of 48%, compared to 28% in the group housed. The most common site of infection in both groups was the nail of the first finger. We, therefore, conclude that there is a difference in the infecting agent in the homeless population and the population with homes.
“…Regarding the toenail anatomical area affected by onychomycosis, our results are in consonance with a recent review carried out in 2022, the first toenail being the most affected area [ 6 ].…”
Section: Discussionsupporting
confidence: 92%
“…With regard to clinical presentation, TDO and MO are the most common among the housed population and among the homeless population DSO and MO. Notwithstanding that fact, we have not found any recent studies that match the clinical presentations of our research since most studies describe that the most frequent clinical presentation is DLSO [ 6 , 21 , 22 ]. This could be explained by our sample size.…”
Section: Discussionmentioning
confidence: 54%
“…The first toenail is the most frequently affected one [ 5 , 6 ]. Changing lifestyles, advanced age, obesity and immunosuppressed states such as diabetes mellitus, organ transplantation, corticosteroid use and antineoplastic drugs are increasing the prevalence of yeast and non-dermatophyte fungal infections [ 5 , 7 ].…”
Onychomycosis is one of the most common foot conditions. Mixed onychomycosis and onychomycosis caused by non-dermatophyte moulds are increasing in incidence, especially in vulnerable populations, hence the importance of this study, which presents the prevalence of onychomycosis in a population of homeless people, comparing the findings with a sample of a well-resourced population. The total sample consisted of 70 participants, divided into two separate groups, a homeless population and a second group in which we included people attending a private clinic. The average age of the sample is [49.19 ± 28.81] with an age range of 18 to 78 years). In the homeless group, the most prevalent infectious agents were non-dermatophyte fungi, with a total of 48%, compared to 28% in the group housed. The most common site of infection in both groups was the nail of the first finger. We, therefore, conclude that there is a difference in the infecting agent in the homeless population and the population with homes.
“… 24 A standardized composite score, such as The Scoring Clinical Index for Onychomycosis, can be used to assess overall disease severity and aid in the development of an individualized treatment plan. 45 Figure 2 Patient with laboratory confirmed onychomycosis. ( A ) Clinical appearance of toenails with onycholysis, nail plate thickening and subungual debris.…”
Section: Clinical Presentationmentioning
confidence: 99%
“…24 A standardized composite score, such as The Scoring Clinical Index for Onychomycosis, can be used to assess overall disease severity and aid in the development of an individualized treatment plan. 45…”
Onychomycosis is the most common nail disease encountered in clinical practice and can cause pain, difficulty with ambulation, and psycho-social problems. A thorough history and physical examination, including dermoscopy, should be performed for each patient presenting with nail findings suggestive of onychomycosis. Several approaches are available for definitive diagnostic testing, including potassium hydroxide and microscopy, fungal culture, histopathology, polymerase chain reaction, or a combination of techniques. Confirmatory testing should be performed for each patient prior to initiating any antifungal therapies. There are several different therapeutic options available, including oral and topical medications as well as device-based treatments. Oral antifungals are generally recommended for moderate to severe onychomycosis and have higher cure rates, while topical antifungals are recommended for mild to moderate disease and have more favorable safety profiles. Oral terbinafine, itraconazole, and griseofulvin and topical ciclopirox 8% nail lacquer, efinaconazole 10% solution, and tavaborole 5% solution are approved by the Food and Drug Administration for treatment of onychomycosis in the United States and amorolfine 5% nail lacquer is approved in Europe. Laser treatment is approved in the United States for temporary increases in clear nail, but clinical results are suboptimal. Oral fluconazole is not approved in the United States for onychomycosis treatment, but is frequently used off-label with good efficacy. Several novel oral, topical, and over-the-counter therapies are currently under investigation. Physicians should consider the disease severity, infecting pathogen, medication safety, efficacy and cost, and patient age, comorbidities, medication history, and likelihood of compliance when determining management plans. Onychomycosis is a chronic disease with high recurrence rates and patients should be counseled on an appropriate plan to minimize recurrence risk following effective antifungal therapy.
BackgroundOnychomycosis (ONM) is the most prevalent nail unit pathology, and its severity and monitoring are often based on the visual judgement of clinicians.ObjectiveThe objective of this study is to assess the reliability of the Onychomycosis Severity Index (OSI) classification when utilized by three clinicians with varying levels of clinical experience: an experienced podiatrist (with 5 years of experience), a moderately experienced podiatrist (with 2 years of experience) and an inexperienced podiatrist (a recent graduate familiar with the OSI classification but lacking clinical experience). Additionally, we compared the severity assessments made through visual inspection with those determined using the OSI by different clinicians.MethodsWe evaluated reliability using the intraclass correlation index (ICC), analysing 50 images of ONM.ResultsThe OSI demonstrated a very high level of reliability (ICC: 0.889) across clinicians, irrespective of their experience levels. Conversely, a statistically significant increase in severity was observed when comparing visual assessments with the OSI (p < .001) for ONM severity evaluation.ConclusionThe OSI proves to be a reproducible classification system, regardless of the clinical experience of the practitioner employing it.
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