Is onychomycosis a risk?

Onychomycosis Is a Significant Health Risk Beyond Cosmetic Concerns

Yes, onychomycosis poses significant health risks beyond cosmetic concerns, including potential complications such as bacterial infections, foot ulcers, and systemic health issues, particularly in vulnerable populations. 1

Clinical Risks of Untreated Onychomycosis

• Onychomycosis can disrupt skin integrity, providing an entry point for bacteria that may lead to foot ulcers, osteomyelitis, cellulitis, and gangrene, especially in diabetic patients 1
• Infected nails serve as a fungal reservoir with potential for spread to other body areas including feet, hands, and groin 1
• The infection is contagious and may spread to other family members if left untreated 1
• Fungal antigens in the nail plate may predispose individuals to other clinical conditions including asthma/respiratory tract sensitization, atopic dermatitis, urticaria, and erythema nodosum 1

Impact on Quality of Life

• Approximately 50% of patients with onychomycosis experience pain or discomfort 1
• About 30% of patients have difficulty wearing footwear 1
• Patients commonly report difficulty walking, emotional embarrassment, and work-related difficulties 1
• Severe cases may negatively impact patients' sex lives 1
• Damaged socks and stockings from friction with sharp, dystrophic nails create additional burdens 1

High-Risk Populations

• Immunocompromised patients face more serious health problems from onychomycosis 2
• Patients with diabetes or peripheral vascular disease are at increased risk for complications such as cellulitis 1
• Elderly individuals have higher prevalence rates (20% in those over 60 years, up to 50% in those over 70) 2
• Transplant recipients and individuals on immunosuppressive treatments are particularly vulnerable 1, 2

Public Health Considerations

• Onychomycosis is highly contagious, with fungal elements protected in small pieces of keratin that can contaminate communal bathing places 1
• Treatment reduces disease prevalence by decreasing the number of infected individuals who can spread the infection 1
• The infection is a significant cause of medical consultation and work absence 1

Common Misconceptions and Pitfalls

• It is a common misconception that onychomycosis is merely a cosmetic problem that doesn't require treatment 1
• The most common cause of treatment failure in the UK is incorrect diagnosis made on clinical grounds alone without laboratory confirmation 1
• High reinfection and recurrence rates make proper diagnosis and complete treatment essential 3
• Onychomycosis should be differentiated from other nail disorders like onychotillomania that require completely different treatments 4

Treatment Considerations

• Oral antifungals (terbinafine, itraconazole) generally have higher cure rates but carry risks of side effects 5, 6
• Topical treatments have more favorable safety profiles but lower efficacy and longer treatment periods 6
• Treatment selection should consider disease severity, infecting pathogen, medication safety, efficacy, cost, and patient factors 6
• Mycological cure rates are typically about 30% better than clinical cure rates in most studies 1

Onychomycosis should be considered a legitimate medical concern requiring proper diagnosis and treatment, not just for cosmetic improvement but to prevent potentially serious complications and improve quality of life 1.