Onychomycosis in Older Adults: Prevalence, Diagnosis, and Management

The risk of having onychomycosis increases with age. Data suggest that the prevalence of onychomycosis may be >= 20% in subjects aged >= 60 years and >= 50% in those aged >= 70 years. Older males are 2.1 times more prone to onychomycosis than are females. Although most nail dystrophies (approximately 50%) are caused by onychomycosis, proper clinical assessment followed by mycological examination is recommended to exclude other conditions such as nail trauma, lichen planus, and psoriasis. The US FDA-approved onychomycosis treatments are systemic antifungals (terbinafine and itraconazole) for severe onychomycosis and topical antifungals (ciclopirox 8%, efinaconazole 10%, and tavaborole 5%) for mild-to-moderate onychomycosis. Oral fluconazole is used off-label, and itraconazole may be considered for non-dermatophyte onychomycosis. Recently, fosravuconazole was approved in Japan for onychomycosis treatment. Although the treatment options and durations are the same for older patients as for other age groups, a clinical decision should take into account various age-related factors such as comorbidities, polypharmacy, hepatic and renal insufficiency, and noncompliance. Clinicians should also consider possible drug interactions and side effects when choosing a particular antifungal. Since the recurrence rate of onychomycosis is high, older patients should practice sanitization techniques, consider lifestyle changes, and perhaps consider using a topical antifungal as long-term maintenance therapy one to three times per week to prevent the recurrence of onychomycosis or to treat early disease.

Automated summary

The risk of onychomycosis increases with age, especially in older males. Proper clinical assessment and mycological examination are recommended to exclude other conditions. Treatment options include systemic and topical antifungals, with recent approval of fosravuconazole in Japan. Clinicians should consider age-related factors and possible drug interactions when making treatment decisions. Older patients should practice sanitization techniques and consider long-term maintenance therapy to prevent recurrence.