Evaluation of Onychomycosis Information on the Internet

May 2019 | Volume 18 | Issue 5 | Editorials | 484 | Copyright © May 2019

Rachel Kang BA,a Shari Lipner MD PhDb

aWeill Cornell Medical College, New York, NY bWeill Cornell Medicine, Department of Dermatology, New York, NY

Onychomycosis is a common and significant nail condition causing both physical and social impairment. Since patients often search for health information online, the accuracy of this information has become important. In this study, we sought to assess the reliability and comprehensibility of accessible internet information for patients searching for onychomycosis. We identified the top search engine hits, evaluating websites on several categories: Accountability, Quality of Medical Information, Readability, Display, Support Features, and Transparency/Disclosures. Utilizing a pro forma based on established internet codes of conduct, website readability scores, and peer-reviewed papers, we objectively analyzed and scored the most commonly-listed websites on onychomycosis. Fifty-one total websites were reviewed with a maximum possible overall score of 43. The mean overall score for all websites was 20 and 1/43 (range, 4-35) with varied Accountability (mean, 4.9/10; range, 0-10) and Quality (mean, 6.4/13; range,1-12/13). Readability was poor overall with only 1/3 of sites meeting the acceptable 7th grade reading level for patients. In addition, while sites such as the American Academy of Dermatology website were well-organized and highly readable (Readability score, 5/5), this may compromise the quality of medical information presented (Quality score, 6/13). Because online education materials set the expectations and concerns of patients with onychomycosis, the variability in website reliability necessitates more efficient and regulated methods of presenting health information.

J Drugs Dermatol. 2019;18(5):484-487.


Onychomycosis is a fungal nail infection accounting for half of all nail conditions seen in clinical practice. It causes both physical and social impairment in patients worldwide,1,2 prompting the search for additional health information. Since the internet has become an increasingly accessible resource for self-directed investigation by patients, the reliability of online material is now an important consideration. This study assesses the most frequently listed websites regarding onychomycosis available to the general public.Using five widely-used search engines (Google, Yahoo, Bing, AOL, and Ask), the terms onychomycosis and nail fungus were respectively queried on each. From these results, the first 20 websites for each term were selected for a total of 200 URLs. Within these, 142 were repeated, 5 required subscription, and 2 were unrelated/nonspecific, yielding a total of 51 analyzable websites.For each site, a predetermined pro forma (Figure 1) was utilized to score reliability based upon several categories: Accountability, Quality of Medical Information, Readability, Display, Support Features, and Transparency/Disclosures. Parameters within Accountability were constructed upon the Health on the Net Code of Conduct3 and Journal of the American Medical Association standard.4 Quality of Information was verified through peer-reviewed papers,1,2 and Readability was scored by Flesch Reading Ease Scores and Flesch-Kincaid Levels.The mean overall score was 20.1/43 (range 4-35). Accountability was variable (range, 0-10/10) with a mean of 4.9—approximately half (53%) listed any references/sources, and only 22% were authored by board-certified dermatologists or podiatrists. Additionally, only 25% were updated within the last year, a potential explanation for incorrect information reported by a few sites, including that “treatment may be initiated on clinical suspicion”.1,2 Other incorrect statements asserted “nail polish as an onychomycosis remedy.” Furthermore, Quality was varied (range, 1-12/13; mean, 6.4), and overall Readability was poor, with only 33% meeting the acceptable 7th grade reading level for health information.While the majority provided relevant images for supplementation, Support Features were lacking (mean, 2.0/8), indicating that outlets for sharing personal experiences or coping strategies were deficient. Table 1 displays the top-scoring websites by overall score and pro forma categories.Surprisingly, the American Academy of Dermatology website did not make the list of top 10 overall highest-scoring websites,