Onychomycosis Treatment Prescribed at Only Twenty Percent of Visits: A Cross-Sectional Analysis of the National Ambulatory Medical Care Survey 2007 to 2016

October 2023 | Volume 22 | Issue 10 | 1040 | Copyright © October 2023


Published online September 29, 2023

Gabrielle M. Peck BAa, Alan B. Fleischer Jr. MDb, Shari R. Lipner MD PhDc

aCollege of Medicine, University of Cincinnati, Cincinnati, OH
bDepartment of Dermatology, University of Cincinnati, Cincinnati, OH
cDepartment of Dermatology, Weill Cornell Medicine, New York, NY

Abstract
Background: Onychomycosis represents the highest proportion of nail disorders seen in clinical practice. Onychomycosis management may differ amongst specialties, with impact on patient outcomes and quality of life (QoL).
Objective: We aimed to characterize onychomycosis treatment across specialties, accounting for patient demographics, to assess for potential onychomycosis practice gaps.
Materials/Methods: We conducted a population based cross-sectional analysis using the National Ambulatory Medical Care Survey (NAMCS) 2007 to 2016 (the most recent years available).
Results: Overall, 71.6% of onychomycosis visits were with general practitioners (GPs), 25.8% with dermatologists, and 2.58% with pediatricians. No onychomycosis treatment was prescribed at 82.0% of dermatology visits and 78.9% of GP visits. Dermatologists (Odds Ratio (OR):2.27 [95% Confidence Interval (CI):[2.14-2.41]; P<0.0001) and GPs (OR:2.32 [2.21-2.44]; P<0.0001) were more likely than pediatricians to prescribe treatment vs no treatment. Dermatologists were more likely than GPs to prescribe both no treatment vs treatment and topical vs oral antifungals (OR:1.33 [1.16-1.52]; P<0.0001 and OR:4.20 [3.80-4.65]; P<0.0001), respectively.
Discussion: Our study showed that there is a low treatment rate for onychomycosis, with treatment prescribed at only 20% of visits. Untreated onychomycosis might result in secondary infection, pain, and negative QoL impact.1 Although dermatologists are specialists in nail disease management, they saw only about 25% of onychomycosis visits. Future efforts should be directed towards promoting onychomycosis therapy, and educating both patients and referring physicians that dermatologists are primary resources for nail disorder treatment.


J Drugs Dermatol. 2023;22(10):1040-1045 doi:10.36849/JDD.6770

INTRODUCTION

Onychomycosis represents the most common nail condition seen in clinical practice amongst adults, comprising 50% of all nail disorders seen in the ambulatory setting.1 Clinically, onychomycosis can present with yellow discoloration and thickening of the nail plate, and interweb and plantar scale.2 Global prevalence is estimated at 2% to 8% of the population, with estimates in North America ranging from 8.7% to 13.8%.2,3 Prevalence increases with age, and patients with psoriasis, diabetes, immunosuppression, poor peripheral circulation, household contacts, tinea pedis, and/or persistent nail trauma have increased susceptibility.2

Onychomycosis imposes a significantly negative impact on quality of life (QoL), which is often underestimated.1 To prevent secondary complications and improve QoL, appropriate treatment for onychomycosis should be offered to patients.2 Onychomycosis management may differ amongst specialties, with impact on patient outcomes. We aimed to characterize onychomycosis treatment across specialties, accounting for patient demographics, to assess for potential onychomycosis practice gaps.

MATERIALS AND METHODS

The National Ambulatory Medical Care Survey (NAMCS) provides objective and reliable data about non-hospital based ambulatory medical services in the United States. The National Center for Health Statistics, a part of the Centers for Disease Control and Prevention (CDC), develops and implements the survey annually. Non-federally employed office-based physicians and advanced practice providers are surveyed during a randomly selected week of the year.4 Survey respondents document patient demographic information, diagnoses,
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