title: Epidemiological study of onychomycosis in older adults with onychodystrophy.
abstract: OBJECTIVE
  To identify the prevalence of onychomycosis and epidemiological features in older adults (>65%) with toenail onychodystrophy. In particular, the aim of the study was to analyze risk factors/protective factors, clinical manifestations, comorbidities and etiological agents.
  
  
  METHODS
  A prospective study was carried out from February 2012 to May 2012 at San Martino-IST of Genoa, Italy. The inclusion criteria for enrolment were the presence of onychodystrophy of one or more toenails and age >65 years. The exclusion criteria were systemic/topical antifungal treatments in the previous 6 months, drilling of the nail plate in the previous 6 months and a specialist's diagnosis or suspicion of onychomycosis. A database was created for the patients' anamnesis, the clinics and testing results. Several statistical analyses were carried out.
  
  
  RESULTS
  A total of 100 patients fulfilled the inclusion criteria. A total of 35 cases had positive results, and the etiological agent was isolable in 14 cases. The most represented was Trichophyton mentagrophytes followed by Trichophyton rubrum and others. Multivariate logistic regression analysis showed the significant roles of sex and diabetes as risk factors, and the use of statins as a protective factor.
  
  
  CONCLUSIONS
  Onychomycosis has a high prevalence in older adults with onychodystrophy. It is important not to overlook onychodystrophy, and to carry out laboratory testing to exclude a fungal infection. In fact, as older patients often cannot undergo systemic antifungal therapies, it is fundamental to treat them early and avoid the spread of infection.
authors.affiliation: DISSAL-University of Genoa-IRCCS Section of Dermatology, AUO San Martino-IST, Genoa, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Cozzani
authors.affiliation: DISSAL-University of Genoa-IRCCS Section of Dermatology, AUO San Martino-IST, Genoa, Italy.
authors.forename: Arianna Fay
authors.initials: AF
authors.lastname: Agnoletti
authors.affiliation: School of Podiatry, University of Genoa, AUO San Martino-IST, Genoa, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Speziari
authors.affiliation: Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Schiavetti
authors.affiliation: Department of Enviroment, Earth, and Life Science (DISTAV), Laboratory of Mycology Corso Dogali, Genoa, Italy.
authors.forename: Mirca
authors.initials: M
authors.lastname: Zotti
authors.affiliation: DISSAL-University of Genoa-IRCCS Section of Dermatology, AUO San Martino-IST, Genoa, Italy.
authors.forename: Agostino
authors.initials: A
authors.lastname: Persi
authors.affiliation: DISSAL-University of Genoa-IRCCS Section of Dermatology, AUO San Martino-IST, Genoa, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Drago
authors.affiliation: DISSAL-University of Genoa-IRCCS Section of Dermatology, AUO San Martino-IST, Genoa, Italy.
authors.forename: Aurora
authors.initials: A
authors.lastname: Parodi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D009260:Nail Diseases / Q000150:complications* / Q000453:epidemiology; D009264:Nails, Malformed / Q000150:complications* / Q000453:epidemiology; D014009:Onychomycosis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000935:Antifungal Agents
keywords: elders; epidemiology; onychodystrophy; onychomycosis; protective factors; risk factors