Infectious Diseases

Optimization of topical therapy for elderly patients with onychomycosis: clinical and epidemiological aspects

Objective: to analyze clinical and epidemiological characteristics of pedal onychomycosis in patients over 65 years of age and to optimize its treatment.
Materials and methods. We performed a retrospective analysis of medical records of patients that underwent examination in the Department of Dermatology, Consultative and Diagnostic Center No. 52 in 2015–2017 (n = 16,514). We compared clinical manifestations of pedal onychomycosis in two groups of patients: Group 1 included patients aged 65–74 years (n = 199), whereas Group 2 comprised patients aged 75–90 years (n = 313). The diagnosis was confirmed by direct microscopy and optical imaging (dermatoscopy). The efficacy of a new treatment method was assessed in 300 patients aged 65 years and older (compared to 150 patients receiving standard therapy).
Results. The majority of patients (87.2%–88.4%) presented with distal lesions of their toenails. Compared with the younger group (<75 years), elderly patients (≥ 75) were found to have more severe disease. Patients aged 75 years and over were more likely to have all nails affected (p = 0.013), involvement of 1/3 of the nail plate (p < 0.001), total form, concomitant cardiovascular disorders (p = 0.046), neurological disorders (p < 0.001), and itching dermatosis (p = 0.025). By contrast, patients aged 65–74 years were more prone to endocrine disorders (p < 0.001), skin cancer (p = 0.021), and fungal infections (p < 0.001). To improve the efficacy and safety of therapy, we have developed a combination treatment strategy (keratolytic agent + topical therapy + instrumental therapy), which ensures more rapid achievement of favorable outcomes in patients with onychomycosis older than 65 years compared to standard therapy after 9 months (96% and 87%; p = 0.004).
Conclusion. Our findings suggest that people over 65 years of age are at higher risk of developing onychomycosis. We recommend implementing our new treatment strategy into routine clinical practice.
Key words: topical therapy, onychomycosis, antifungals.
For citation: Gerasimchuk E.V. Optimization of topical therapy for elderly patients with onychomycosis: clinical and epidemiological aspects. Infekc. bolezni (Infectious diseases). 2019; 17(2): 74–80. (In Russian).

DOI: 10.20953/1729-9225-2019-2-74-80