Onychomycosis in the Elderly

Sohn, Jae Kyung; Lee, Si Heon

Abstract

BACKGROUND: Onychomycosis is a common disease and has a tendency to increase in its incidence. Although there have been many reports about onychomycosis, very few studies about onychomycosis in the elderly have yet been conducted.
OBJECTIVE
The purpose of this study was to investigate the clinical and mycological features of onychomycosis in the elderly, and to evaluate the concept and attitude of the elder patients towards onychomycosis, which would affect the treatment and further infections of onychomycosis. METHOD: Sixty eight onychomycosis patients over 60 years old were examined clinically and surveyed by questionnaire to evaluate their concern about the onychomycosis. All the patients were confirmed by potassium hydroxide (KOH) examinations and underwent cultures on the both cornmeal potato agar with and without cycloheximide. An additional culture was done a week later when the initial culture showed contamination or no growth.
RESULTS
Among 648 patients with onychomycosis, 68 patients (10.5%) were over 60 years old. Fifty (73.5%) were female and 18 (26.5%) were male. Twenty six (38.2%) had systemic illness. The average duration of onychomycosis was 13 years and the average number of onychomycosis involving nails was 4.7. Sixty three patients (92.6%) had toe nail onychomycosis. Sixty six patients (97.1%) showed distal subungal onychomycosis. Trichophyton rubrum was the main causative organism in 38 patients (55.9%). Forty one patients (60.3%) discontinued the medication in 4 weeks, and 11 (16.2%) were treated over 12 weeks. From the questionnaire, only 10 patients reported previous treatment for this problem, but with duration of treatment no longer than one month. Fifty three patients had mere understanding atypical alternation in their nails before the visit. The main reasons of the discontinuing the medication were the cost of the treatment, physical discomfort due to age, and extended duration of the therapy.
CONCLUSION
From this study, we noticed that the elder onychomycosis patients could be long time carriers of fungi because of their lack of the knowledge of onychomycosis and insufficient treatment. Therefore, it is necessary to educate and support to treat the elder patients effectively.