Written by Emma Leigh, Medical Writing Lead.

Blueberry Therapeutics hopes to make a real difference to the quality of life for people who suffer from skin and nail conditions by curing the symptoms they experience. To do this, it is key to understand exactly what issues affect people with these conditions, how this makes them feel, and how much this impacts their daily way of life.

Our most advanced area of research is fungal infection of the nails, also called onychomycosis, which leads to thickening, splitting, roughening, discolouration and eventually destruction of the nail. This is an extremely common ailment that affects hundreds of millions of people around the world, with prevalence rates up to 23% in Europe, 20% in East Asia and 14% in North America.1 Experts believe that these rates are set to increase even further, partly because of our ageing population, increased migration and changes in lifestyle.

Nail infections should not be considered as simply a cosmetic problem but need to be recognised as an important condition that must be treated. Firstly, for medical reasons as they can lead to more serious infections elsewhere in the body, infections in other family members, and can cause other medical complications. And secondly, as the impact on an individual can be considerable – sadly much greater than is generally recognised. Patients can suffer pain, disability, psychological and social problems, which can affect their work and leisure activities, and ultimately reduce their quality of life.2 Therefore, treatment is key, but importantly, a treatment that fixes the problem without it recurring.

Various studies have assessed the specific effects of toenail onychomycosis on patients’ lives3,4 and suggest toenail pain to be present in approximately 50% of patients, with 20% avoiding social activities due to onychomycosis. Most patients (approximately 80%) have problems wearing shoes and difficulty in cutting their toenails. In a large scale project called Achilles, which questioned over 43,000 patients with foot diseases visiting their doctor or dermatologist, 37% of patients with onychomycosis reported having discomfort on walking, 29% suffered pain, 30% were embarrassed by their condition, and 19% were limited in their daily activities. This clearly shows that fungal nail infection is not just a cosmetic issue but affects the well-being of patients.

Treatment and prevention practices for nail infections can further restrict personal lifestyle and leisure activities, and these practices often need to be maintained for over 12 months. These generally include a combination of proper hygiene/footcare along with medical treatment to prevent re-infection and the infection of others. For example, nails need to be kept short, dry and clean, socks should be changed frequently, and patients are asked not to go barefoot in public places. Therefore, visiting places such as pools, spas, beaches, saunas or gyms, or participating in certain sports activities (e.g., gymnastics or martial arts) may be compromised.

Increased mental burden is common in onychomycosis, with some reports suggesting 92% of patients experience psychological and psychosocial effects.5 Specific problems include anxiety, depression, low body image and self-esteem, and deterioration of sense of worth. These can cause a person to drop out of their usual social circles, which can have further consequences for their mental state. Fingernails in particular are seen as an outward sign of good health and well-being, so it is not surprising that patients with fingernail infections have more psychological issues than those with infections of the toenail.

Taken together, these physical and mental issues mean that onychomycosis can have a huge negative effect on a person’s quality of life. In fact, some have suggested that the magnitude of these effects is comparable to that of conditions like non-melanoma skin cancers and benign growths, which may have been assumed to be more serious.4 When developing new treatments for onychomycosis, understanding the issues patients face will allow us to better focus on the patient as well as the disease.

References

  1. Ghannoum M and Isham N. Fungal nail infections (onychomycosis): a never-ending story? PLoS Pathogen 2014;10(6):e1004105.
  2. Thomas J, Jackson GA, Narkowicz CK et al. Toenail onychmycosis: an important global disease burden. J Clin Pharm Ther 2010;35:497-519.
  3. Daniel Onychomycosis: burden of disease and the role of topical antifungal treatment. J Drugs Dermatol 2013;12(11):1263-66.
  4. Gupta AK and Mays RR. The Impact of onychomycosis on quality of life: a systematic review of the available literature. Skin Appendage Disord 2018;4:208–216.
  5. Elewski BE. The effect of toenail onychomycosis on patient quality of life. Int J Dermatol 1997;36:754-56.