Naildex: pilot evaluation of an onychodystrophy severity instrument

Abstract

SummaryA valid and reliable measure that captures onychodystrophy disease severity is important for both clinical and research applications. Three hundred and twenty-two patients at two Veterans Affairs Medical Centers with clinical evidence of onychodystrophy suggesting onychomycosis (at least 25% in a distal subungual pattern) were examined using Naildex parameters. Naildex scores were calculated by a combination of: per cent of each nail infected, area of each nail and number of infected nails. Patients also completed a nail-specific quality of life questionnaire (NailQoL) and nail samples were collected and examined mycologically. Data was analysed for all enrolled patients (n = 322) and patients with mycologically-confirmed onychomycosis (n = 243). Inter-rater reliability was calculated from two examiners who each evaluated 17 patients with mycologically-confirmed onychomycosis. Significant correlations (P < 0.01) between Naildex and NailQoL as well as proxy measures (duration of infection) indicated construct validity of the instrument for all patients as well as mycologically-confirmed cases. Strong correlation (r = 0.754, P < 0.01, n = 17) indicated high inter-rate reliability. This pilot evaluation suggests that Naildex is a valid and reliable measure of onychomycosis severity.

Onychophagia is Associated with Impairment of Quality of Life

“…Several studies demonstrate that nail diseases, albeit affecting a rather small portion of the body surface might cause significant impairment of QoL (13,(25)(26)(27)(28)(29). Comparing onychophagia with onychomycosis or nail psoriasis, the impairment in onychophagia patients, based on NailQoL, was smaller than in the 2 latter conditions.…”

Management of Onychomycosis in Canada in 2014

“…Extent of nail involvement, nail thickening, onycholysis, clinical presentation, proximity to the matrix, presence of dermatophytoma, and factors influencing nail growth, such as the location (fingernail versus toenail) and age of the patient, have been used to design severity index scores. [76][77][78][79] Unfortunately, the severity of the infection at baseline is not always reported in clinical trials, and in cases where it is reported, there is no standardization enabling cross-study comparisons. Indeed, severity was reported as matrix/lunula involvement, mild to severe, percentages of affected nail area, millimeters of healthy nail, and severity index score.…”

Recurrence, reinfection and long-term efficacy of antifungals in onychomycosis by 2013

“…Этому может способствовать разочарование наших коллег поисками более точных средств диагностики, особенно неудачами европейских систем ПЦР [41], и последовательным неприз нанием четырех европейских и американских систем клинической оценки онихомикоза [42,43,44].Отсутствие консенсуса зарубежных дер матологов в отношении достоверных клини ческих признаков и предикторов эффективно сти лечения онихомикоза позволяет разным авторам выдвигать собственные критерии оценки. В их число могут входить площадь и глубина поражения, его специфическая локали зация в пределах ногтя, наличие особых редких клинических форм или иные клинико эпидеми ологические факторы, не имеющие непосред ственного отношения к наблюдаемой картине онихомикоза -например, иммунодефицит, са харный диабет, травма и патология стопы [37].…”