A practical application of onychomycosis cure – combining patient, physician and regulatory body perspectives

• Published in: Journal of the European Academy of Dermatology and Venereology 2019-02, Vol.33 (2), p.281-287
• Main Authors: Gupta, A.K., Versteeg, S.G., Shear, N.H.
• Format: Article
• Language: English
• Subjects: Administration, Oral; Administration, Topical; Antifungal Agents - administration & dosage; Attitude of Health Personnel; Female; Foot Dermatoses - diagnosis; Foot Dermatoses - drug therapy; Humans; Laser Therapy - methods; Male; Onychomycosis - diagnosis; Onychomycosis - drug therapy; Onychomycosis - surgery; Physician-Patient Relations; Prognosis; Quality of Life; Recurrence; Risk Assessment; Severity of Illness Index; Treatment Outcome
• ISSN: 0926-9959; 1468-3083
• DOI: 10.1111/jdv.15181

Due to the high relapse rates and the rise of predisposing factors, the need for curing onychomycosis is paramount. To effectively address onychomycosis, the definition of cure used in a clinical setting should be agreed upon and applied homogeneously across therapies (e.g. oral, topical and laser treatments). In order to determine what is or what should be used to define cure in a clinical setting, a literature search was conducted to identify methods used to evaluate treatment success. The limitations, strengths, prevalence and utility of each outcome measure were investigated. Seven ways to measure treatment success were identified; mycological cure, patient/investigator assessments, complete cure, quality of life instruments, severity indexes, clinical cure and temporary clearance. Despite its shortcomings, mycological cure is the most objective and consistent outcome measure used across onychomycosis studies. It is suggested that diagnostic goals of onychomycosis should be used to define cure in a clinical setting. Modifications to outcome measures such as incorporating molecular‐based techniques could be a future avenue to explore.