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

<b><i>Introduction:</i></b> 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). <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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 &lt;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. <b><i>Discussion:</i></b> 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.

<b><i>引言：</i></b> 甲真菌病（onychomycosis）是一种常见且难以治愈的甲部真菌感染。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（QOL）造成负面影响。<b><i>方法：</i></b> 本项事后分析研究，采用OnyCOE-t™问卷的患者自评得分，分析10%依芬康唑（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、治疗满意度及总体问题七大维度。评分越高代表功能状态越好，生活质量亦越高。<b><i>结果：</i></b> 10%依芬康唑治疗与临床疗效，在所有分组的各维度上均与生活质量改善呈正相关，仅40岁以下女性患者的症状困扰程度维度除外（该维度指甲真菌病症状对患者造成的担忧或困扰程度）。尽管在有效治疗期间，多数维度仍呈现改善趋势，但女性及年轻患者报告的生活质量评分仍低于同龄男性与年长患者，即便其在随访时获得了更优的临床结局。<b><i>讨论：</i></b> 无论治疗成功与否或指甲外观是否得到改善，女性及年轻患者似乎都更容易因症状产生情绪困扰，这表明甲真菌病不仅局限于甲部病变，还对这类患者造成了更显著的心理影响。因此，年轻女性患者或许需要更多的心理疏导与情感支持。