Mohammad KA Basra; Muhammad Shahrukh


Expert Rev Pharmacoeconomics Outcomes Res. 2009;9(3):271-283. 

In This Article


Onychomycosis accounts for 18-40% of all nail diseases and 30% of cutaneous fungal infections.[144] The incidence is between 2 and 13% and increases with age. Overall, 15-20% of the population suffering from onychomycosis is in the age range of 40-60 years.[145]

Physical inconvenience may occur in the form of difficulty in nail-trimming, pain, nail pressure and discomfort wearing shoes (38%).[146,147] Ability to pick up small objects could be impaired in subjects with fingernail involvement.[147] Onychomycosis is also associated with emotional and social implications leading to reduced self-esteem and limitations of interaction with others. With regard to toenails, fungal dystrophy may interfere with walking and sports activities.[147] Owing to the abnormal appearance of nails, individuals experience considerable embarrassment when they have to expose their nails to others and fear intimate situations. Many have difficulty with work-related activities which require them to use their fingers or to be on their feet for long periods of time.[148]

Due to its widespread prevalence in the community onychomycosis has an important economic impact. In a study of patients 65 years old and over 1.3 million clinic visits were recorded in 1 year costing more than US$43 million.[146] The cost of therapy for toenail onychomycosis with terbinafin in Canadian dollars was estimated to be $1049.77, for griseofulvin $1388.54 and for ketoconazole it was $1936.48.[149] Moreover, some work loss has been documented in the form of onychomycosis-related sick leaves.[147]


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