Evaluation of the Knowledge of Primary Care Physicians About Important Nail Diseases Before and After a Short Online Training

Pauline Greco; Félix  Pham; Gérard Duru; Xavier Lainé; Stéphane Dalle; Luc Thomas

doi:10.5826/dpc.1303a170

Evaluation of the Knowledge of Primary Care Physicians About Important Nail Diseases Before and After a Short Online Training

Authors

Pauline Greco Dermatology department, Hôpital Lyon Sud, Hospices Civils de Lyon; Claude Bernard Lyon-1 University, Lyon, France
Félix Pham uDermatology department, Hôpital Lyon Sud, Hospices Civils de Lyon; Claude Bernard Lyon-1 University, Lyon, France
Gérard Duru Claude Bernard Lyon-1 University, Lyon, France
Xavier Lainé Claude Bernard Lyon-1 University, Lyon, France
Stéphane Dalle Dermatology department, Hôpital Lyon Sud, Hospices Civils de Lyon; Claude Bernard Lyon-1 University; Cancer Research Center of Lyon, Lyons, France
Luc Thomas Dermatology department, Hôpital Lyon Sud, Hospices Civils de Lyon; Claude Bernard Lyon-1 University; Cancer Research Center of Lyon, Lyons, France

Keywords:

nail, primary care physician, education, general practitioner, melanoma

Abstract

Introduction: Nail diseases are often diagnosed late with a potential prognostic and functional im-pact. This could be partly due to knowledge gaps among primary care physicians (PCPs).

Objectives: To evaluate the knowledge about diagnosis and management of ten common/important nailconditions in a population of French PCPs and its improvement after a 31-minute online training session.

Methods: We submitted 10 pre-test and post-test clinical cases and an educative online course on the diagnosis and the management of nail diseases to 138 volunteer PCPs; 73 completed the whole training path.

Results: Compared to pre-test, more PCPs in the post-test required an urgent second opinion to der-matologist for pigmented melanoma (100% versus 80.3%; P <0.05) and use of inappropriate/danger-ous systemic treatment for trauma-induced nail changes was reduced after the training program (0% versus 6.8%; P <0.05).A lack of knowledge remained after training for amelanotic melanoma with an increase of mycological/bacteriological tests (9.6% versus 0%; P <0.05).

Conclusions: Management of nail diseases by our panel of PCPs was suboptimal and was improved after a short online training.

Author Biographies

Pauline Greco, Dermatology department, Hôpital Lyon Sud, Hospices Civils de Lyon; Claude Bernard Lyon-1 University, Lyon, France

1Dermatology +33 4 78 86 33 33 department, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyons, France

2Claude +33 4 26 23 71 55 Bernard Lyon-1 University, Lyon, France

Félix Pham, uDermatology department, Hôpital Lyon Sud, Hospices Civils de Lyon; Claude Bernard Lyon-1 University, Lyon, France

Dermatology +33 4 78 86 33 33 department, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyons, France

Claude +33 4 26 23 71 55 Bernard Lyon-1 University, Lyon, France

References

Lipner SR, Scher RK. Onychomycosis – a small step for quality of care. Curr Med Res Opin. 2016;.;32(5):865-867. DOI: 10.1185/03007995.2016.1147026. PMID: 26807603.

Nguyen JT, Bakri K, Nguyen EC, Johnson CH, Moran SL. Surgical management of subungual melanoma: mayo clinic experience of 124 cases. Ann Plast Surg. 2013;71(4):346-354. DOI: 10.1097/SAP.0b013e3182a0df64. PMID: 24025653.

Wollina U, Tempel S, Hansel G. Subungual melanoma: A single center series from Dresden. Dermatol Ther. 2019;32(5):e13032. DOI: 10.1111/dth.13032. PMID: 31344289.

Phan A, Touzet S, Dalle S, Ronger-Savlé S, Balme B, Thomas L. Acral lentiginous melanoma: a clinicoprognostic study of 126 cases. Br J Dermatol. 2006;155(3):561-569. DOI: 10.1111/j.1365-2133.2006.07368.x. PMID: 16911282.

Natarajan V, Nath AK, Thappa DM, Singh R, Verma SK. Coexistence of onychomycosis in psoriatic nails: a descriptive study. Indian J Dermatol Venereol Leprol. 2010;76(6):723. DOI: 10.4103/0378-6323.72468. PMID: 21079333.

Girisha BS, Shenoy MM, Mathias M, Mohan R. Glomus tumor of the nail unit. Indian J Dermatol. 2011;56(5):583-584. DOI: 10.4103/0019-5154.87163. PMID: 22121286. PMCID: PMC3221231.

Jawalkar H, Maryada VR, Brahmajoshyula V, Kotha GK. Subungual glomus tumors of the hand: Treated by transungual excision. Indian J Orthop. 2015;49(4):403-407. DOI: 10.4103/0019-5413.159611. PMID: 26229160. PMCID: PMC4510793.

Chakera AH, Quinn MJ, Lo S, Drummond M, et al. Subungual Melanoma of the Hand. Ann Surg Oncol. 2019;26(4):1035-1043. DOI: 10.1245/s10434-018-07094-w. PMID: 30565042.

Talavera-Belmonte A, Bonfill-Ortí M, Martínez-Molina L, et al. Subungual Melanoma: A Descriptive Study of 34 Patients. Actas Dermosifiliogr (Engl Ed). 2018;109(9):801-806. DOI: 10.1016/j.ad.2018.06.010. PMID: 30082026.

Dijksterhuis A, Friedeman E, van der Heijden B. Squamous Cell Carcinoma of the Nail Unit: Review of the Literature. J Hand Surg Am. 2018;43(4):374-379.e2. DOI: 10.1016/j.jhsa.2018.01.010. PMID: 29482957.

Sureda N, Phan A, Poulalhon N, Balme B, Dalle S, Thomas L. Conservative surgical management of subungual (matrix derived) melanoma: report of seven cases and literature review. Br J Dermatol. 2011;165(4):852-858. DOI: 10.1111/j.1365-2133.2011.10477.x. PMID: 21812768.

Topin-Ruiz S, Surinach C, Dalle S, Duru G, Balme B, Thomas L. Surgical Treatment of Subungual Squamous Cell Carcinoma by Wide Excision of the Nail Unit and Skin Graft Reconstruction: An Evaluation of Treatment Efficiency and Outcomes. JAMA Dermatol. 2017;153(5):442-448. DOI: 10.1001/jamadermatol.2017.0014. PMID: 28384651. PMCID: PMC5817490.

Papachristou DN, Fortner JG. Melanoma arising under the nail. J Surg Oncol. 1982;21(4):219-222. DOI: 10.1002/jso.2930210405. PMID: 7144198.

Iorizzo M. Tips to treat the 5 most common nail disorders: brittle nails, onycholysis, paronychia, psoriasis, onychomycosis. Dermatol Clin. 2015;33(2):175-183. DOI: 10.1016/j.det.2014.12.001. PMID: 25828710.

Schneider SL, Tosti A. Tips to diagnose uncommon nail disorders. Dermatol Clin. 2015;33(2):197-205. DOI: 10.1016/j.det.2014.12.003. PMID: 25828712.

Maddy AJ, Tosti A. What's New in Nail Disorders. Dermatol Clin. 2019;37(2):143-147. DOI: 10.1016/j.det.2018.12.004. PMID: 30850036.

Thomas J, Jacobson GA, Narkowicz CK, Peterson GM, Burnet H, Sharpe C. Toenail onychomycosis: an important global disease burden. J Clin Pharm Ther. 2010;35(5):497-519. DOI: 10.1111/j.1365-2710.2009.01107.x. PMID: 20831675.

Dalle S, Depape L, Phan A, Balme B, Ronger-Savle S, Thomas L. Squamous cell carcinoma of the nail apparatus: clinicopathological study of 35 cases. Br J Dermatol. 2007;156(5):871-874. DOI: 10.1111/j.1365-2133.2006.07744.x. PMID: 17263801.

Elewski BE. Onychomycosis: pathogenesis, diagnosis, and management. Clin Microbiol Rev. 1998;11(3):415-429. DOI: 10.1128/CMR.11.3.415. PMID: 9665975. PMCID: PMC88888.

Summerbell RC, Cooper E, Bunn U, Jamieson F, Gupta AK. Onychomycosis: a critical study of techniques and criteria for confirming the etiologic significance of nondermatophytes. Med Mycol. 2005;43(1):39-59. DOI: 10.1080/13693780410001712043. PMID: 15712607.