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TOPLINE:

Patients with onychodystrophy who have a history of tinea pedis, chronic kidney disease, peripheral vascular disease, or type 2 diabetes are at an increased risk of having onychomycosis.

METHODOLOGY:

• Because of increasing antifungal resistance, an accurate diagnosis is important to provide appropriate treatment to patients with onychodystrophy.
• To identify factors associated with histopathologically confirmed onychomycosis in patients with onychodystrophy, researchers evaluated data on 1256 patients with onychodystrophy seen at Weill Cornell Medicine from January 2013 to October 2020, in a retrospective case-control study.
• Most (67.9%) were under the age of 65, 70.8% were female, and 70.8% were White. Overall, 47% of patients had onychomycosis.

TAKEAWAY:

• Tinea pedis (odds ratio [OR], 10.3; P < .001), chronic kidney disease (OR, 2.3; P = .04), peripheral vascular disease (OR, 2.1; P < .01), and type 2 diabetes (OR, 1.6; P = .03) were associated with a significantly increased risk for onychomycosis.
• Age, body mass index, race/ethnicity, smoking status, immunosuppression, history of malignancy, and hyperhidrosis were not associated with an increased risk for onychomycosis.
• Tinea pedis (OR, 11.4; P < .001) and peripheral vascular disease (OR, 1.9; P = .04) were positive predictors of onychomycosis.
• A history of psoriasis (OR, 0.4; P < .001) and female sex (OR, 0.6; P < .01) were negative predictors of onychomycosis.

IN PRACTICE:

The results "argue against empiric treatment, as visual examination and patient-level factors may not reliably indicate onychomycosis," the authors wrote, "and may help dermatologists identify patients more likely to have onychomycosis, encouraging appropriate testing and antifungal stewardship."

SOURCE:

The study, led by Eden Axler, BS, Department of Dermatology, Weill Cornell Medicine, New York City, was published online on May 14, 2024, in the Journal of the American Academy of Dermatology.

LIMITATIONS:

The study was limited by its retrospective nature, single-center design, and small sample size. Data on the severity of the underlying condition were not available.

DISCLOSURES:

The study did not receive any funding. The authors declared no conflicts of interest.