Should onychomycosis be included in the patient linelist?

From the Guidelines

Onychomycosis should be included in the patient linelist, especially if tracking fungal infections or dermatological conditions, as it allows for proper monitoring of treatment outcomes and assessment of risk factors in the patient population. Onychomycosis is a fungal infection of the nails, typically caused by dermatophytes, yeasts, or non-dermatophyte molds, and represents a significant portion of nail disorders in clinical practice 1. Including it in a patient linelist enables the identification of potential outbreaks and the implementation of preventive measures in high-risk populations.

Key Considerations

• Treatment typically involves oral antifungals like terbinafine (250 mg daily for 6-12 weeks) or itraconazole (200 mg daily for 12 weeks or pulse therapy), with terbinafine being considered the first choice due to its higher efficacy and tolerability 1.
• Topical options such as ciclopirox nail lacquer or efinaconazole can be used for milder cases, with efinaconazole showing promising results in recent studies 1.
• The condition has a high recurrence rate and can significantly impact patient quality of life, especially in immunocompromised individuals or those with diabetes.

Management and Prevention

• Tracking cases of onychomycosis through a linelist helps in evaluating treatment efficacy, managing chronic cases, and implementing preventive measures in high-risk populations.
• Regular monitoring and follow-up are crucial to prevent recurrence and manage potential complications.
• Patient education on proper nail care and hygiene practices can also help prevent the spread of infection and reduce the risk of recurrence.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Onychomycosis Inclusion in Patient Linelist

• Onychomycosis is a chronic fungal infection of the nail that can cause pain, difficulty with ambulation, and psycho-social problems 2.
• The disease has high recurrence rates, and patients should be counseled on an appropriate plan to minimize recurrence risk following effective antifungal therapy 2.
• Various therapeutic options are available, including oral and topical medications as well as device-based treatments 2.
• 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 2.

Diagnosis and Management

• A thorough history and physical examination, including dermoscopy, should be performed for each patient presenting with nail findings suggestive of onychomycosis 2.
• Confirmatory testing should be performed for each patient prior to initiating any antifungal therapies 2.
• 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 2.

Treatment Options

• 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 2.
• Amorolfine 5% nail lacquer is approved in Europe 2.
• Laser treatment is approved in the United States for temporary increases in clear nail, but clinical results are suboptimal 2.
• Oral fluconazole is not approved in the United States for onychomycosis treatment, but is frequently used off-label with good efficacy 2.

Inclusion in Patient Linelist

• Given the complexity of onychomycosis diagnosis and management, it is reasonable to include onychomycosis in the patient linelist to ensure comprehensive care and follow-up 3, 4, 5, 2, 6.