Perceptions and Management Practices of Onychomycosis Among Thai Physicians

Pichaya  Limphoka; Charussri  Leeyaphan; Chudapa  Sereeaphinan; Pattriya  Chanyachailert; Sumanas  Bunyaratavej; Carren  Hau

doi:10.33192/smj.v75i2.260741

Authors

Pichaya Limphoka Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Charussri Leeyaphan Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Chudapa Sereeaphinan Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Pattriya Chanyachailert Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Sumanas Bunyaratavej Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Carren Hau Section of Dermatology, Department of Internal Medicine, Manila Doctors Hospital, Manila

DOI:

https://doi.org/10.33192/smj.v75i2.260741

Keywords:

Mycological laboratory, general practitioners

Abstract

Objective: To examine the proportion of physicians who conducted mycological laboratory procedures to confirm a diagnosis of onychomycosis. The secondary purpose was to evaluate the practical management of physicians, comparing general practitioners and dermatology-related physicians.

Materials and Methods: This cross-sectional study and questionnaire-based research was conducted during 2021-2022. The questionnaire was composed of questions related to the practical management of onychomycosis, including diagnosis and treatment.

Results: Overall, 143 physicians were recruited to take part in this study. The number of physicians who conducted direct examination with potassium hydroxide was 99 (69.2%). The number of dermatology-related physicians who conducted mycological laboratory examinations to confirm the diagnosis was significantly higher than among general physicians (95.8% vs. 52.2%; p<0.001). Feet examination and determination of poor prognostic factors, such as elderly age, nail thickness, presence of dermatophytoma and nondermatophytes infection, were done by the dermatology-related physicians in significantly higher numbers. Blood testing before starting treatment for onychomycosis with oral antifungal medications seemed to be higher (87.5%) in the dermatology-related group. Moreover, mycological re-evaluation after treatment cessation was more significantly requested by the dermatologyrelated participants (75% vs. 15.8%, p<0.001).

Conclusion: Laboratory confirmation, feet examination, and the recognition of poor prognostic factors were significantly lower in the general practitioner group. These findings should raise awareness for improving further education about onychomycosis management in medical students, since mycological laboratory examination is crucial for diagnosis and it is helpful in guiding the proper disease management for complete disease remission.

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