Date of Conferral

1-1-2008

Degree

Doctor of Public Health (DrPH)

School

Public Health

Advisor

Ming Ji

Abstract

Prevalence of onychomycosis, as high as 26.9% in the general population, can be reduced by improving current antifungal treatment. This could be accomplished by understanding prognostic factors, especially healthy nail growth, associated with achieving complete cure. This population-based study aimed to evaluate if healthy nail length or percentage of total full nail length as healthy can be early indictors for complete cure. Logistics regression analyses were performed by comparing variables between a population who achieved the complete cure and a population who failed after both populations received the same antifungal treatment in two large randomized double-blinded clinical trials that assessed drug efficacy. Results showed that the largest odds ratios for healthy nail length (mm) and percent of total nail grown as healthy (%) were achieved at Week 12 with 1.63 and 1.07, respectively. Mean healthy nail length at Week 12 was 3.56 mm among cured patients and 1.90 mm among failed patients. Other significant baseline factors for the cure were: younger in age; naive to antifungal treatment; and having less severe disease. Growth of healthy nail during the treatment period is significantly associated with achievement of complete cure. Treatment success might be improved by monitoring the healthy nail growth. This study bears public health importance and can foster positive social changes because better managed disease can improve patient's quality of life and reduce financial burdens to the healthcare system. It could also be a tool for researchers to filter out better drug candidates and reduce research costs therefore cheaper treatments.

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