189 From the Department of Dermatology, Massachusetts General Hospital, Boston a ; University of Washington, Seattle b ; Department of Dermatology, Saint-Pierre University Hospital, Brussels c ; Nail Disease Center, Cannes d ; Klinikum der Stadt Wuppertal,Wuppertal-Eberfeld e ;MAPI,Lyon f ;and the Instituto di Clinica Dermatologica,Universita degli Studi di Bologna. g The Onychomycosis and Quality of Life Questionnaire was devel- oped for this study by MAPI,Lyon,France,and was supported by Janssen Pharmaceutica. Accepted for publication March 8,1999. Reprint requests: Lynn A. Drake, MD, Massachusetts General Hospital, Department of Dermatology, 40 Blossom St-BAR 604, Boston,MA 02114-2696. Copyright © 1999 by the American Academy of Dermatology,Inc. 0190-9622/99/$8.00 + 0 16/1/98290 O nychomycosis is a common, chronic dis- ease with a substantial negative effect on the quality of life of those who suffer from it. 1-4 Nevertheless, the perception still persists in the minds of many physicians that onychomycosis is more of a cosmetic nuisance than a significant dis- ease. 1 Onychomycosis accounts for half of all nail dis- orders and about one third of cutaneous fungal infections. 1,2 Dermatophytes are responsible for approximately 90% of onychomycosis cases, with nondermatophyte molds and Candida spp account- ing for the remainder. A recent survey of adults in the United Kingdom showed that the prevalence of dermatophyte nail infection was 2.6% and 2.8% in females and males, respectively 5 ; comparable figures have been reported in the United States. Prevalence rates in the elderly are considerably higher, and, in the 40– to 60-year-old age range, rates of 15% to 20% have been estimated. 6 Moreover, the prevalence of onychomycosis is rising, probably because of a com- bination of factors related to enhanced risk of infection and increased case detection. 1 Thus an increasingly aged population, greater use of immunosuppressive drugs, growing numbers of per- sons immunosuppressed through HIV infection, The impact of onychomycosis on quality of life: Development of an international onychomycosis-specific questionnaire to measure patient quality of life Lynn A. Drake, MD, a Donald L. Patrick, PhD, b Philip Fleckman, MD, b Josette André, MD, c Robert Baran, MD, d Eckart Haneke, MD, e Claudine Sapède, f and Antonella Tosti, MD g Boston, Massachusetts; Seattle, Washington; Brussels, Belgium; Cannes and Lyon, France; Wuppertal-Ebefeld, Germany; and Bologna, Italy Background: Onychomycosis is a widespread refractory disease deleteriously affecting quality of life via social stigma and disrupting daily activities. Many physicians perceive onychomycosis as a cosmetic rather than a medical problem. Objective: Our purpose was to develop a questionnaire-based instrument to quantify the impact of onychomycosis on patients’ quality of life. Methods: The questionnaire was developed and validated in a multinational cross-sectional study. Completed questionnaires from 532 patients were analyzed: 284 toenail, 248 fingernail (onychomycosis or paronychia). Re su lts: The degree of quality of life impairment from onychomycosis varied by country studied, possibly reflecting cross-national health perception differences. Longer duration of disease, greater involvement of individual nails, and greater number of nails involved were associated with more serious adverse effects. Many physicians underestimated the associated degree of pain. Conclusion: The study confirms that onychomycosis physically and psychologically affects patients’ lives. The questionnaire may be a valuable tool in evaluating the effect of therapeutic agents on quality of life of patients with onychomycosis. (J Am Acad Dermatol 1999;41:189-96.)