The effect of itraconazole pulse therapy on quality of life in Pakistani patients of distolateral subungual onychomycosis

Abstract

Background Distal and lateral subungual onychomycosis (DLSO) is the most commonclinical type of onychomycosis. The disease causes little physical handicap but it has adevastating effect on quality of life (QOL) particularly in our set up.Objective The purpose of the study was to assess the effect of itraconazole pulse therapy onquality of life in Pakistani patients with DLSO.Methods Sixty-two patients, 47 males and 15 females suffering from DLSO, age range 19 to55 years, who were themselves able to understand and fill the questionnaire related withgeneral and disease-specific QOL in English or Urdu version, were enrolled in the study. Thetotal score ranged from 0-60. The higher the score, the greater was the impact on QOL. Thepatients were subjected to itraconazole pulse therapy and each pulse consisted of 200 mgtwice a day for 7 days, followed by a drug-free interval of three weeks. Two pulses weregiven for fingernail onychomycosis and three pulses for toenail infection. The pre- and posttrialdata was analyzed before and after therapy in 46 finger- and 16 toenail cases of DLSO.Results The disease caused psychosocial problems (92%), economic problems in treatment(89.4%), difficulty in cutting nails (62.9%), physical contact problems with hands (60.8%),discomfort in wearing shoes and walking (56.2%), pain (33.8%), disturbance of work withhands (30.4%) and affected performance in sports (22.5%). After itraconazole pulse therapy,these problems decreased to 12.9%, 14.5%, 6.45%, 6.4%, 12.5%, 4.8%, 6.45% and 3.2%,respectively. The mean pretreatment score in patients with finger- and toenail disease was32+3.4 and 29+4.5, respectively. The score dropped to 4.3+5.4 and 4.4+5.6 (P<0.05) afteritraconazole therapy at last follow-up 32 weeks and 48 weeks for finger- and toenail disease,respectively. Fingernail disease has affected QOL more than toenail disease and longerduration of disease, greater involvement of individual nails and greater number of nailsinvolved was also associated with more serious impact on QOL. Females were found to bemore psychologically upset than males.Conclusion Itraconazole pulse therapy significantly improves the QOL in disto-lateralsubungual onychomycosis of both finger- and toenails in our patients.