Objectives : We investigated the actual status of antifungal agents for onychomycosis, including percentages of drugs prescribed and drug selection by onychomycosis subtype after 18months of topical onychomycosis agent launch. Survey method : We received responses from 137 hospital dermatologists (HP) and 203 general practice dermatologists (GP) nationwide pharmacologically treating 10 or more onychomycosis patients in the prior month. This internet survey was conducted between March 2 and 8, 2016. Results and discussion : The mean number of patients receiving pharmacological therapy per month was 42.1. Distal and lateral subungual onychomycosis (DLSO) was the most common subtype (46.3% of total), followed by total dystrophic onychomycosis (TDO) at 18.9%, spike-shaped at 17.5%, superficial white onychomycosis (SWO) at 10.9%, and proximal subungual onychomycosis (PSO) at 6.4%. Oral agents (including topical agent combinations) were used by 13.5 patients (32.0%), topical agent for onychomycosis by 18.4 (43.7%), and existing topical agents without indication by 9.5 (22.5%), showing topical agent for onychomycosis to be most commonly used by both HP and GP. Oral agents were highly evaluated for "high clinical effect," topical agent for "high safety," and existing topical agents without indication for "high safety" and "drug price." The first-line therapies by subtype excluding severe DLSO and TDO were topical agent for onychomycosis. Although treatment selection should be based on subtype and severity, topical agent is presumably selected frequently for their high safety. The percentage of patients cured was highest among those receiving oral agents, then topical agent and, finally, existing topical agents without indication. Although oral agents exert superior treatment effects, safety often takes precedence over efficacy. However, the treatment objective is cure; therefore, highly effective drugs must be selected by subtype and severity.

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Objectives The goal of the study was to determine the rates of xeroderma, itch, problems caused by adhesive skin patches, and countermeasures against such problems in facilities for the elderly. Methods An Internet-based questionnaire survey was administered to 1,000 physicians working in facilities for elderly people. Results and Discussion Answers suitable for analysis were obtained from 210 physicians (response rate: 21.0%). In facilities in which treatment by a physician was available, xeroderma with itch or without itch occurred in 37.0% of residents. This rate is lower than the previously reported rate, suggesting that some cases are overlooked. Skin care with a moisturizing agent was provided to 39.7% of the residents who received examinations, and this rate was similar to the prevalence of xeroderma. This suggests that a moisturizing agent is used when a diagnosis of xeroderma is made in facilities for the elderly. However, this also means that no moisturizing agent is used when xeroderma is not confirmed, resulting in insufficient skin care. The rate of use of an adhesive skin patch was 17.5% in residents who received examinations. The incidence of skin symptoms caused by such a patch was 22.7%, and these symptoms led to 32.6% of the residents suspending or stopping use of the patch. Daily skin care for xeroderma is needed to improve skin symptoms caused by an adhesive skin patch. Nurses informed physicians of patients with xeroderma in over 70% of cases. Most physicians in facilities for the elderly are not dermatologists, and therefore it is particularly important to strengthen relationships with medical staff and to educate and enlighten staff about the problems of dry skin.

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