Onychomycosis: health-related quality of life considerations

The symptoms of onychomycosis and their impact on personal appearance are important determinants of patients' perceptions of their own health. The effect of onychomycosis is greater on psychosocial than physical functioning and is directly related to the extent of nail involvement. This review identified a number of disease-targeted questionnaires that have been developed to assess the impact of onychomycosis and its treatment on health-related quality of life (HR-QOL). The instruments differ considerably in the extent to which they have been psychometrically tested. Most have been shown to provide both valid and reliable measurement of HR-QOL in patients with onychomycosis of the toes. However, not all have been tested in patients with fingernail disease. The generic and disease-targeted scales of most of the available questionnaires exhibit poor variability, which may limit their responsiveness to clinically important change. Only one instrument, the Onychomycosis Disease-Specific Questionnaire, has been incorporated into a clinical trial. Thus, information relating to the impact of onychomycosis treatment on HR-QOL is limited. Future efforts should focus on the systematic evaluation of existing questionnaires in all populations for which they were developed. In addition, it is important that disease-targeted measures be included in future clinical trials so that a better understanding of the impact of onychomycosis treatment on patient HR-QOL may be gained.