Guidelines of Treatment of Onychomycosis

抄録

Onychomycosis is a common disease which can affect anyone - men and women, old and young and accounts for approximately 23% of diagnosed foot diseases¹. In addition, according to community studies have generally estimated a prevalence of approximately 3-5% in the general population. The majority of onychomycosis infections are associated with current or past dermatophyte infection of the feet². Toe nails were affected 8 times more frequently than finger nails and nails of big toes and thumbs were affected in 89.1% and 69.5% of the patients respectively³.
The main types are distal and lateral onychomycosis, proximal subungual onychomycosis, superficial onychomycosis and total dystrophic onychomycosis. In addition, patients may show different combinations of these patterns. Concerning a treatment, it can be categorized into three board groups: oral treatment, topical treatment and surgical/chemical avulsion of the nail plate. However, there are some specific difficulties and it is a source of frustration for many dermatologists. As a consequence, for the first time, possibility to establish international guidelines for the treatment of onychomycosis is discussed by the Taskforce on Onychomycosis Education(TOE).
TOE is the first international board of key opinion leaders on onychomycosis, it was established with 13 international opinion leaders specialized in the field. One of the purposes of this board is that to establish international guidelines for treatment of onychomycosis. As a results, the latest consensus guidelines, primarily discuss therapeutic recommendations⁴, which is published on JEADV in 2005, was discussed during the 2^nd international TOE meeting. This practical guideline for treatment of onychomycosis will certainly be helpful for both physicians and patients.
However, there is no guideline for Asia country yet; therefore, it is time to generate an Asia of credible guidelines made by experts, in which all published guidelines from other countries will also be taken into account. It provides a guide to identify and effectively manage patients with onychomycosis.

References:
1. Roseeuw D. Achilles foot screening project : preliminary results of patients screened by dermatologists. J Eur Acad Dermtol Venereol 1999; 12: S6-9
2. Williams HC. The epidemiology of onychomycosis in Britain. Br J Dermatol 1993; 129: 101-9
3. Lee JM, Shin DH, Choi JS, Kim KH. Analysis of treatment of patients with tinea unguium and assessment of the real Effectiveness of antifungal agents and patient compliance. Korean J Dermatol 1998 ; 36(5) : 772-779
4. Lecha M, Effendy I, Feuilhade de Chauvin M, et al. Treatment options-development of consensus guidelines. J Eur Dermatol Venereol 2005 ; 19 (Suppl I) 25-33