Albucker Samantha Jo, Falotico Julianne M, Choo Zi-Ning, Matushansky Justin T, Lipner Shari R
Tulane University School of Medicine, New Orleans, LA 70112, USA.
Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA.
J Fungi (Basel). 2023 Jun 29;9(7):712. doi: 10.3390/jof9070712.
: Onychomycosis is the most common nail disorder seen in clinical practice, and it may have significant impact on patient quality of life. Understanding risk factors for onychomycosis may help to devise screening and treatment guidelines for populations that are more susceptible to this infection. Using a national database, we aimed to explore associations between onychomycosis and age, sex, and underlying medical conditions, as well as to examine current onychomycosis treatment trends. : We performed a nested, matched, case-control study of patients in the All of Us database aged ≥ 18 years (6 May 2018-1 January 2022). Onychomycosis cases were identified using International Classification of Diseases (ICD) and Systematized Nomenclature of Medicine (SNOMED) diagnostic codes (ICD-9 110.1, ICD-10 B35.1, SNOMED 414941008). Demographic information (i.e., age, sex, and race), treatments, and co-diagnoses for onychomycosis patients and case-controls were recorded. Wald's test applied to multivariate logistic regression was used to calculate odds ratios and -values between onychomycosis and co-diagnoses. Additionally, 95% confidence intervals were calculated with a proportion test. : We included 15,760 onychomycosis patients and 47,280 matched controls. The mean age of onychomycosis patients was 64.9 years, with 54.2% female, 52.8% Non-Hispanic White, 23.0% Black, 17.8% Hispanic, and 6.3% other, which was similar to controls. Patients with onychomycosis vs. controls were more likely to have a co-diagnosis of obesity (46.4%, OR 2.59 [2.49-2.69]), tinea pedis (21.5%, OR 10.9 [10.1-11.6]), peripheral vascular disease (PVD) (14.4%, OR 3.04 [2.86-3.24]), venous insufficiency (13.4%, OR 3.38 [3.15-3.59]), venous varices (5.6%, OR 2.71 [2.47-2.97]), diabetes mellitus (5.6%, OR 3.28 [2.98-3.61]), and human immunodeficiency virus (HIV) (3.5%, OR 1.8 [1.61-2.00]) ( < 0.05, all). The most frequently prescribed oral and topical medications were terbinafine (20.9%) and ciclopirox (12.4%), respectively. The most common therapeutic procedure performed was debridement (19.3%). Over the study period, ciclopirox prescriptions (Spearman correlation 0.182, = 0.0361) and fluconazole prescriptions increased (Spearman correlation 0.665, = 2.44 × 10), and griseofulvin (Spearman correlation -0.557, = 0.0131) and itraconazole prescriptions decreased (Spearman correlation -0.681, = 3.32 × 10). : Our study demonstrated that age, obesity, tinea pedis, PVD, venous insufficiency, diabetes mellitus, and HIV were significant risk factors for onychomycosis. In addition, the most frequent oral and topical onychomycosis medications prescribed were terbinafine and ciclopirox, likely reflective of efficacy and cost considerations. Identifying and managing these risk factors is essential to preventing onychomycosis' primary infections and recurrences and improving treatment efficacy.
甲癣是临床实践中最常见的指甲疾病，可能对患者生活质量产生重大影响。了解甲癣的危险因素有助于为更易感染这种疾病的人群制定筛查和治疗指南。我们利用一个全国性数据库，旨在探究甲癣与年龄、性别及基础疾病之间的关联，并研究当前甲癣的治疗趋势。
我们在“我们所有人”数据库中对年龄≥18岁（2018年5月6日至2022年1月1日）的患者进行了一项嵌套、匹配的病例对照研究。使用国际疾病分类（ICD）和医学系统命名法（SNOMED）诊断代码（ICD - 9 110.1、ICD - 10 B35.1、SNOMED 414941008）来识别甲癣病例。记录了甲癣患者及病例对照的人口统计学信息（即年龄、性别和种族）、治疗情况及合并诊断。应用于多变量逻辑回归的 Wald 检验用于计算甲癣与合并诊断之间的比值比和P值。此外，通过比例检验计算95%置信区间。
我们纳入了15760例甲癣患者和47280例匹配对照。甲癣患者的平均年龄为64.9岁，女性占54.2%，非西班牙裔白人占52.8%，黑人占23.0%，西班牙裔占17.8%，其他占6.3%，与对照相似。与对照相比，甲癣患者更有可能合并肥胖（46.4%，比值比2.59 [2.49 - 2.69]）、足癣（21.5%，比值比10.9 [10.1 - 11.6]）、外周血管疾病（PVD）（14.4%，比值比3.04 [2.86 - 3.24]））、静脉功能不全（13.4%，比值比3.38 [3.15 - 3.59]）、静脉曲张（5.6%，比值比2.71 [2.47 - 2.97]）、糖尿病（5.6%，比值比3.28 [2.98 - 3.61]）和人类免疫缺陷病毒（HIV）（3.5%，比值比1.8 [1.61 - 2.00]）（所有P < 0.05）。最常开具的口服和外用药物分别是特比萘芬（20.9%）和环吡酮（12.4%）。最常见的治疗操作是清创术（19.3%）。在研究期间，环吡酮处方量增加（斯皮尔曼相关性0.182，P = 0.0361），氟康唑处方量增加（斯皮尔曼相关性0.665，P = 2.44×10⁻⁴），而灰黄霉素（斯皮尔曼相关性 - 0.557，P = 0.0131）和伊曲康唑处方量减少（斯皮尔曼相关性 - 0.681，P = 3.32×10⁻⁵）。
我们的研究表明，年龄、肥胖、足癣、PVD、静脉功能不全、糖尿病和HIV是甲癣的重要危险因素。此外，最常开具的甲癣口服和外用药物是特比萘芬和环吡酮，这可能反映了疗效和成本方面的考虑。识别和管理这些危险因素对于预防甲癣的初次感染和复发以及提高治疗效果至关重要。
