Treatment for onychomycosis prescribed at only 20% of visits, impacting quality of life

Key takeaways:

• No prescription was prescribed in 82% of the dermatology visits for onychomycosis vs. 78.9% of general practitioner (GP) visits.
• Dermatologists were more likely to not write a prescription vs. GPs (OR = 1.33).

Patients with onychomycosis experience low treatment rates with treatments being prescribed in 20% of all visits for this condition, according to a study.

“Onychomycosis represents the most common nail condition seen in clinical practice amongst adults, comprising 50% of all nail disorders seen in the ambulatory setting,” Gabrielle M. Peck, BA, of University of Cincinnati College of Medicine, and colleagues wrote. “Global prevalence is estimated at 2% to 8% of the population, with estimates in North America ranging from 8.7% to 13.8%.”

Onychomycosis presents itself as yellow discoloration and thickening of the nail plate. The condition’s prevalence increases with age, and susceptibility is greater among patients with psoriasis, diabetes, immunosuppression, poor peripheral circulation, household contacts, tinea pedis or persistent nail trauma.

According to the study, secondary complications can be prevented and quality of life improved when onychomycosis treatments are offered to patients; however, patients often do not receive treatment.

In a population based cross-sectional analysis using data from 2007 to 2016 from the National Ambulatory Medical Care Survey, Peck and colleagues found that 71.6% of 337 million onychomycosis visits were with general practitioners (GPs), whereas only 25.8% were with dermatologists. Also, 2.58% of visits were with pediatricians.

Patients that visited dermatologists were on average older compared with those that visited GPs (mean age, 59.4 years vs. 49.5 years).

No prescription was prescribed in 82% of the dermatology visits vs. 78.9% of GP visits, making dermatologists significantly more likely to not write a prescription compared with GPs (OR = 1.33; 95% CI, 1.16-1.52).

Of the treatments that were prescribed, ciclopirox was the most common among dermatologists, prescribed in 27.2% of visits that ended in prescription write-up. Efinaconazole (26.5%) and terbinafine (19.8%) were the next most common prescriptions written by dermatologists.

GPs wrote many prescriptions for ciclopirox (56%) followed by terbinafine (27.9%) and itraconazole (8.01%). Topical treatments were prescribed at 57% of GP visits compared with 60.7% of dermatology visits, making dermatologists significantly more likely than GPs to prescribe a topical over an oral antifungal (OR = 4.2; 95% CI, 3.8-4.65).

The authors concluded that there is a low treatment rate for onychomycosis, with only 20% of visits ending in a prescription write-up, even though topical and oral antifungals have shown to improve patients’ quality of life.

“Lack of treatment is likely due to onychomycosis educational gaps, including misperceptions of [quality of life] impact,” Peck said. “Future efforts should be directed towards promoting effective management of onychomycosis across diverse patient populations, and educating both patients and referring physicians that dermatologists are primary resources for nail disorder treatment.”