Qualidade de vida, autocuidado e gestão do tratamento farmacológico em pessoas com onicomicoses

Introduction: Onychomycosis (OM) is a fungal nail infection with an estimated prevalence between 0.5-26% in the world and with an increasing trend. OM is a risk factor for foot ulcers and acute bacterial cellulitis, particularly in diabetics. OM is associated with changes in quality of life (QOL), triggering physical, mental, social problems, and compromising activities of daily living. OM onset is facilitated by morphological anomalies in the nails, nail trauma, inadequate footwear, frequent use of public spas and poor hygiene conditions. The most severe cases tend to occur in people with chronic diseases and / or immunosuppression states. OM is often resistant to current treatments. Objectives: Describe the prevalence of OM in a clinical sample. Evaluate QOL and translate the questionnaire (OnyCOE-t TM) to be used with the Portuguese population. Characterize the style of therapeutic management regime (TMR). Test the in vitro fungicidal activity of antiseptics in clinical species and American Type Culture Collection (ATCC). Methodology: Four studies were carried out with different materials and methods. A cross-sectional study was conducted to assess the prevalence of OM. A subsample of the prevalence study was used to translate and adapt the questionnaire (OnyCOE-t TM). A subsample of the prevalence study was used to identify Therapeutic Management Regimen (TRM) styles and associated features. Lastly, an in vitro study of fungicidal activity of antiseptics, was performed on the clinical fungi identified in the prevalence study. Inclusion criteria were: individuals over 18 years old with clinical suspicion of OM. Exclusion criteria were: Patients who used antifungals in the last three months, patients with cognitive impairments. The present study was approved by the ethics committee and all patients gave free and informed consent to participate. Results: The prevalence of OM was of 53.3% confirmed through laboratory testing. The most prevalent fungus was T. rubrum (38.6%). Participants reported difficulties in feet self-care (74.4%), discomfort (66%), nail thickening (90.0%), as well as shame and embarrassment due to OM (37.8%). The majority of the sample (54.4%) had had OM for more than 5 years. The translation of the OnyCOE-t TM questionnaire revealed good internal consistency (Cronbach's alpha> 0.725). Analysis of therapeutic regimen management (TRM) style showed that 12.5% of the sample had a predominantly responsible style, with characteristics of control and flexibility and remoteness from the negligent style. Difficulty in self-care was not associated with the TRM style (p = 0.493). The in vitro study demonstrated that the antiseptic solutions of Povidone iodine (PVP-I) and Octenidine (OCT-D) were the most effective against the clinical species T. rubrum, T. interdigitale, and C. parapsilosis, with a reduction of 99.99% (log> 4). Discussion/Conclusion: The present study contributed to a better description of the epidemiology of OM. The translation of the OnyCOE-t TM questionnaire suggests that this is a useful and reliable tool for carrying out QOL studies in the Portuguese population. A cluster of common characteristics was found for all TMR. The antiseptics PVP-I and OCT-D demonstrated potential in vitro for use in OM. Experimental studies should be carried out, considering nurses' knowledge of the clinical practice of using antiseptics, in order to improve QOL and promote self-care for people with OM.