Purpose: Reasons for onychomycosis treatment discontinuation were explored and the possible clinical approaches were discussed. Methods: Patients diagnosed to have onychomycosis were asked to complete an internet questionnaire. Two groups of patients were selected, those who had “self-judged to have healed” and/or “self-discontinued the treatment” (treatment discontinued group: hereafter, discontinued group), and those who had been “judged by physicians to have healed” (treatment completed group: hereafter, completed group). The genders and ages were equally balanced between the discontinued and the completed groups. The responses of the two groups were compared. Results: The trial involved a total number of 416 individuals, 208 patients in each group. The number of patients using topical agent medication was high in the discontinued group. Patients in the completed group generally received an extensive explanation of onychomycosis at the time of diagnosis and clear instructions on appropriate medication from the prescribing physicians. “Lack of subjective symptoms resulting in the abandonment of treatment,” “too cumbersome to continue treatment,” “nail conditions have improved with drug,” and “difficulty in finding time for the treatment” were the main reasons for discontinuation. Comparison between the groups highlighted that in order for the treatment to be continued and be successful, “early efficacy realization,” “a short drug treatment period time,” and “effective clinical care and support” were necessary. Conclusions: The reasons for treatment discontinuations were lack of understandings of the disease, self-judgement of the efficacy, and long treatment or hospital attending period. In order to successfully complete onychomycosis treatment leading to a full recovery, patients should be given a full explanation about onychomycosis by physicians, and follow-up appointments including nail care should be made available. Also, the choice of drugs suitable for disease types, individual backgrounds and lifestyles of patients was found to be important.

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We developed a method termed “lip-shaped” incision, which enables the resection of epidermal cysts with a small incision. This method is characterized by the combination of two incisions. First, a shallow spindle-shaped incision including the keratin-filled punctum is made on the surface of an epidermal cyst. Next, a deep incision is made in the middle of the spindle-shaped incision along the long axis to cut through the cyst wall, and contents are squeezed out from the incision as much as possible. The cyst wall can then be removed from the spindle-shaped incision by continuously separating it from the tissue. The cyst may be removed completely if there is no adhesion or scarring. We treated 97 patients with inflammatory epidermal cysts using this method, and achieved a 3-year recurrence rate of 8% (n=8). We further treated 26 patients with non-inflammatory epidermal cysts and recurrence was seen in one patient with adhesion in the cyst wall (4%). For epidermal cysts ≥ 2 cm in size, the lip-shaped incision allows the removal of contents and total excision of the cystic wall with an incision line only about half of the cyst diameter. Even for inflammatory epidermal cysts, our findings suggest that an incision and drainage performed simultaneously with cyst wall removal can reduce the recurrence rate.

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