Are there any specific patient populations or comorbidities that require a modified approach to the management of onychomycosis?

Yes, specific patient populations and comorbidities necessitate a modified approach to the management of onychomycosis.

People who are immunocompromised or have comorbid conditions such as diabetes are more likely to experience severe, refractory fungal nail infections that may not respond to standard treatments and have an increased risk of complications. These patients may require prolonged antifungal treatment courses and specialist referral for advanced management options, including combination therapy and possible nail debridement or avulsion.

Children under 12 years also require specialist management because oral antifungal treatments are off-label and topical treatments are often ineffective or off-label in this age group.

In people with diabetes, especially those with diabetic foot problems, careful assessment is needed to exclude other causes of foot pathology and to manage any concomitant infections appropriately, as fungal nail infections can complicate diabetic foot care.

Therefore, management should be tailored considering these populations’ increased risk of treatment failure, complications, and the need for specialist input.

Self-care advice and antifungal treatment options should be discussed with all patients, but especially emphasised in these groups to prevent reinfection and complications.

Referral to podiatry or dermatology is recommended for severe disease, treatment failure, uncertain diagnosis, or in immunocompromised patients.

Topical treatments may be less effective in these populations, and oral antifungal therapy or combination approaches may be necessary.

Overall, a modified, often more intensive and multidisciplinary approach is required for these specific patient groups.

References: ¹,²,³