Patient Characteristics, Diagnostic Testing Utilization, and Antifungal Prescribing Pattern for Onychomycosis in the USA: A Cohort Study Using DataDerm, 2016–2022

Abstract: Introduction: Onychomycosis is a complex nail disease that is commonly seen in daily practice. Methods: Electronic health records of clinically diagnosed onychomycosis patients were extracted using DataDerm – a dermatology data registry hosted by the American Academy of Dermatology – spanning from the year 2016 to 2022. Results: Regardless of age, an increasing trend in patient volume was observed in the Southern US region, which accounted for 50.7–56.9% of onychomycosis patients in 2022. A coinfection of tinea pedis was present among 15.6–22.5% of patients. Diagnostic testing was infrequently utilized with less than one-quarter of patients having a histopathologic examination (12.7–21.9%) followed by fungal culture (5.5–8.2%) and direct microscopic examination (3.3–6.0%). Treatments were infrequently prescribed, accounting for less than one-quarter of patients (orals, terbinafine: 20.8–29.1%, fluconazole: 12.9–16.5%; topicals, efinaconazole: 3.2–13.8%); over 30% of treated patients received a combination regimen or experienced switching of treatments. Prescribing patterns did not significantly differ in vulnerable patient groups such as elderly patients and in patients with concomitant tinea pedis. Patients receiving a topical and/or oral antifungal prescription were frequently not tested to confirm the onychomycosis diagnosis (76.9%). Conclusion: Our findings add to a growing body of literature calling for the improvement of onychomycosis management practices. Introduction: Onychomycosis is a complex nail disease that is commonly seen in daily practice. Methods: Electronic health records of clinically diagnosed onychomycosis patients were extracted using DataDerm – a dermatology data registry hosted by the American Academy of Dermatology – spanning from the year 2016 to 2022. Results: Regardless of age, an increasing trend in patient volume was observed in the Southern US region, which accounted for 50.7–56.9% of onychomycosis patients in 2022. A coinfection of tinea pedis was present among 15.6–22.5% of patients. Diagnostic testing was infrequently utilized with less than one-quarter of patients having a histopathologic examination (12.7–21.9%) followed by fungal culture (5.5–8.2%) and direct microscopic examination (3.3–6.0%). Treatments were infrequently prescribed, accounting for less than one-quarter of patients (orals, terbinafine: 20.8–29.1%, fluconazole: 12.9–16.5%; topicals, efinaconazole: 3.2–13.8%); over 30% of treated patients received a combination regimen or experienced switching of treatments. Prescribing patterns did not significantly differ in vulnerable patient groups such as elderly patients and in patients with concomitant tinea pedis. Patients receiving a topical and/or oral antifungal prescription were frequently not tested to confirm the onychomycosis diagnosis (76.9%). Conclusion: Our findings add to a growing body of literature calling for the improvement of onychomycosis management practices. Introduction: Onychomycosis is a complex nail disease that is commonly seen in daily practice. Methods: Electronic health records of clinically diagnosed onychomycosis patients were extracted using DataDerm – a dermatology data registry hosted by the American Academy of Dermatology – spanning from the year 2016 to 2022. Results: Regardless of age, an increasing trend in patient volume was observed in the Southern US region, which accounted for 50.7–56.9% of onychomycosis patients in 2022. A coinfection of tinea pedis was present among 15.6–22.5% of patients. Diagnostic testing was infrequently utilized with less than one-quarter of patients having a histopathologic examination (12.7–21.9%) followed by fungal culture (5.5–8.2%) and direct microscopic examination (3.3–6.0%). Treatments were infrequently prescribed, accounting for less than one-quarter of patients (orals, terbinafine: 20.8–29.1%, fluconazole: 12.9–16.5%; topicals, efinaconazole: 3.2–13.8%); over 30% of treated patients received a combination regimen or experienced switching of treatments. Prescribing patterns did not significantly differ in vulnerable patient groups such as elderly patients and in patients with concomitant tinea pedis. Patients receiving a topical and/or oral antifungal prescription were frequently not tested to confirm the onychomycosis diagnosis (76.9%). Conclusion: Our findings add to a growing body of literature calling for the improvement of onychomycosis management practices.
Onychomycosis refers to a fungal infection of the nail unit; it is the most common cause of nail disease worldwide that can present with nail plate discoloration, thickening, and separation. Despite common misconceptions, onychomycosis is beyond just a cosmetic concern which can cause localized pain and numbness as well as difficulty walking. In this study, we reviewed the electronic health records of 152,850 patients diagnosed with onychomycosis by dermatologists in the USA from 2016 to 2022. We identified a heightened healthcare burden in the US South Census region, likely due to the warm and humid environment that increases the risk of fungal infections. This trend has increased overtime where over half of the patients were seen in the US South Census region in 2022. Furthermore, we identified concerning trends regarding the diagnosis and treatment of onychomycosis. Despite a well-recognized risk of misdiagnosis due to this condition mimicking other non-fungal diseases such as psoriasis and trauma, testing was conducted in less than 25% of patients to confirm the diagnosis. Treatment was also infrequently prescribed to patients, accounting for up to only 25%. For vulnerable patients – the elderly and patients with tinea pedis (fungal foot infection) – the likelihood of receiving treatment did not increase. Lastly, for patients who received treatments including oral treatments associated with side-effects, 76.9% of them did not receive testing to confirm the diagnosis before treatment. Taken together, these findings highlight areas where the current onychomycosis management practices can be improved.

Angaben zum Objekt

• Standort: Deutsche Nationalbibliothek Frankfurt am Main
• Umfang: Online-Ressource
• Sprache: Englisch

Verweise und Beziehungen

• Erschienen in: Patient Characteristics, Diagnostic Testing Utilization, and Antifungal Prescribing Pattern for Onychomycosis in the USA: A Cohort Study Using DataDerm, 2016–2022 ; volume:11 ; number:1 ; year:2025 ; pages:36-44 ; extent:9 ; Skin appendage disorders ; 11, Heft 1 (2025), 36-44 (gesamt 9)

Beteiligte, Orts- und Zeitangaben

• Urheber: Gupta, Aditya K. ; Wang, Tong ; Tran, Anh N.

Weitere Informationen

• DOI: 10.1159/000540704
• URN: urn:nbn:de:101:1-2502192319006.423552560290
• Rechteinformation: Open Access; Der Zugriff auf das Objekt ist unbeschränkt möglich.
• Letzte Aktualisierung: 15.08.2025, 07:21 MESZ