Shahbaz Aman, Talat M Akbar, Ijaz Hussain, Muhammad Jahangir, Tahir S Haroon.
The effect of Itraconazole pulse therapy on quality of life in Pakistani patients of distolateral subungual Onychomycosis.
J Pak Assoc Derma Jan ;14(4):198-204.

Background: Distal and lateral subungual onychomycosis (DLSO) is the most common clinical type of onychomycosis. The disease causes little physical handicap but it has a devastating 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 on quality of life in Pakistani patients with DLSO. Methods: Sixty-two patients, 47 males and 15 females suffering from DLSO, age range 19 to 55 years, who were themselves able to understand and fill the questionnaire related with general and disease-specific QOL in English or Urdu version, were enrolled in the study. The total score ranged from 0-60. The higher the score, the greater was the impact on QOL. The patients were subjected to itraconazole pulse therapy and each pulse consisted of 200 mg twice a day for 7 days, followed by a drug-free interval of three weeks. Two pulses were given for fingernail onychomycosis and three pulses for toenail infection. The pre- and posttrial data 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 with hands (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 was 32+3.4 and 29+4.5, respectively. The score dropped to 4.3+5.4 and 4.4+5.6 (P<0.05) after itraconazole 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 longer duration of disease, greater involvement of individual nails and greater number of nails involved was also associated with more serious impact on QOL. Females were found to be more psychologically upset than males. Conclusion: Itraconazole pulse therapy significantly improves the QOL in disto-lateral subungual onychomycosis of both finger- and toenails in our patients.

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