PREVALENCE AND EPIDEMIOLOGY OF TOENAIL ONYCHOMYCOSIS IN DIABETIC SUBJECTS - A MULTICENTER SURVEY

The number of individuals diagnosed with diabetes mellitus is increasi ng, The diabetic may present with complications involving all systems of the body. While onychomycosis is often observed in diabetics, there have been no large studies on the prevalence of the condition in this patient group, We examined the prevalence of onychomycosis in diabeti cs attending diabetes and dermatology clinics in London, Ontario, Cana da and Boston, MA, U.S.A. Diabetic subjects seen in dermatology office s were for unrelated dermatoses; those referred specifically for the m anagement of onychomycosis were excluded from the sample. A total of 5 50 diabetic subjects was evaluated (283 males and 267 females), age 56 .1 +/- 0.7 years (mean +/- SEM). Patients with type I diabetes constit uted 34% of the sample, The racial origin was: 531 Caucasians, 17 Asia ns, one African-American and one American-Indian. Abnormal-appearing n ails and mycological evidence of onychomycosis (mostly due to dermatop hytes) were present in 253 (46%) and 144 (26%), respectively, of 550 s ubjects. The development of onychomycosis was significantly correlated with age (P < 0.0001) and male gender (P < 0.0001). Males were 2.99 t imes more likely to have onychomycosis compared with females (95% conf idence interval, CI 1.94-4 61). After controlling for age and sex, the risk odds ratio for diabetic subjects to have toenail onychomycosis w as 2.77 times compared with normal individuals (95% CI 2.15-3.57). Aft er controlling for age and sex, a stepwise logistic regression demonst rated that significant predictors for onychomycosis included a family history of onychomycosis (P = 0.0001), concurrent intake of immunosupp ressive therapy (P = 0.035) and peripheral vascular disease (P = 0.023 ). Toenail onychomycosis was present in 26% of the sample and is proje cted to affect approximately one-third of subjects with diabetes, Pred isposing factors include increasing age, male gender, family history o f onychomycosis, concurrent intake of immunosuppressive agents and per ipheral vascular disease.