[Management of presumed onychomycosis in private practice]

The aim of this cross-sectional epidemiological survey was to describe the demographic and clinical characteristics of patients consulting for presumed onychomycosis and methods of treatment used by dermatologists in private practice.

The study was conducted among 209 dermatologists in private practice, and involved 2 041 patients with dermatomycosis, from among whom we isolated a total of 531 subjects with onychomycosis.

The most commonly affected site was the foot (92.3%), particularly the big toe (93.9%). Matrix involvement was seen in 46.9% of cases. The clinically suspected diagnosis was confirmed by mycological examination in just under half of these patients. The predominance of trichophyton species was confirmed in 64.4% of cases, with Trichophyton rubrum being the main agent (53.2%) followed by Trichophyton mentagrophytes (10.1%). Results were negative in 25.6% of cases. In most instances, treatment was initiated before the results for samples analysis were received. Oral treatment, either with or without topical therapy, was initiated in 85.3% of cases with matrix involvement and in 34% of cases without matrix involvement.

This survey reveals a wide disparity in diagnostic criteria for onychomycosis as well as treatment methods among dermatologists in private practice. Mycological samples, which alone can confirm the fungal origin of onychopathy, were taken in less than half of all the cases studied. The most commonly prescribed oral treatment was terbinafine. This was frequently instituted in the absence of any matrix involvement and without confirmation of the diagnosis.