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

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.

Keywords: amorolfine; ciclopirox; debridement; efinaconazole; itraconazole; laser therapy; nail fungus; onychomycosis; patient-reported outcome measures; photodynamic therapy; quality of life; terbinafine; topical therapy.