Supplementary Material for: More than Nail Deep: The Effect of Efinaconazole 10% Treatment on the Quality of Life in Patients with Onychomycosis: A post hoc Study

Introduction: Onychomycosis is a common, difficult-to-treat fungal nail infection. Clinical signs include nail discoloration and thickening, which patients often find embarrassing, causing a negative impact on their quality of life (QOL). Methods: In this post hoc study, we analyze the effect of efinaconazole 10% solution on a patient’s QOL using patient-reported scores from the OnyCOE-t™ questionnaire (appearance, stigma, physical problems, symptom frequency, symptom bothersomeness, treatment satisfaction, and overall problem). Higher scores corresponded to better functioning, thus higher QOL. Results: Efinaconazole 10% treatment and clinical efficacy were positively correlated with improved QOL in all domains for all groups, except with symptom bothersomeness (how much the onychomycosis symptoms worried or concerned the patient) for female patients <40 years. While still showing improvement in most domains during efficacious treatment, female and younger patients reported lower QOL scores than their male and older counterparts, despite having better clinical outcomes at follow-ups. Discussion: Female and younger patients appear to be more emotionally bothered by their symptoms, regardless of treatment success or improvement of their nail’s appearance, suggesting that onychomycosis is more than nail deep and has a greater psychological effect on these patients. Therefore, younger female patients may require more assurance and mental support.引言：甲真菌病（Onychomycosis）是一种常见且难治的甲部真菌感染性疾病。其临床体征表现为指甲变色与增厚，患者常因此感到窘迫，对生活质量（quality of life, QOL）造成负面影响。 方法：本项事后分析（post hoc study）研究采用OnyCOE-t™问卷收集的患者报告结局评分，分析10%依非康唑（efinaconazole）溶液对患者生活质量的影响。该问卷涵盖外观、病耻感、躯体问题、症状频率、症状困扰程度、治疗满意度以及整体问题七个维度。评分越高代表机体功能状态越好，生活质量亦越高。 结果：10%依非康唑治疗与临床疗效，在所有分组的所有维度中均与各领域生活质量的改善呈正相关，仅40岁以下女性患者的症状困扰程度维度（即甲真菌病症状对患者的困扰程度）除外。尽管在有效治疗期间，多数维度仍呈现改善趋势，但相较于男性及年长患者，女性与年轻患者报告的生活质量评分更低，即便在随访时他们取得了更优的临床结局。 讨论：无论治疗是否成功或指甲外观是否得到改善，女性与年轻患者似乎都更容易受到症状带来的情绪困扰，这表明甲真菌病并非仅局限于甲部病变，对这类患者的心理影响更为显著。因此，年轻女性患者或许需要更多的心理疏导与精神支持。