Prevalence, Risk Factors and Treatment of Occupational Onychomychosis among Carpet Manufacture Workers in Egypt

Abstract Background: Onychomycosis is a chronic fungal infection of the nail, characterized by nail discoloration, subungual hyperkeratosis, and onycholysis. The involved pathogens are dermatophytes, yeasts (Candida), and non-dermatophyte molds (NDMs). Onychomycosis occurs worldwide and accounts for up to 50% of all nail infections and 30% of all superficial fungal infections of the skin. Onychomycosis represents a therapeutic challenge because of the high recurrence rate. Moreover, it requires long treatment duration and systemic rather than topical antifungal agent because onychomycosis-related subungual hyperkeratosis limits the penetration with topical antifungal drugs, in addition to the slow nail growth, the physical presence of nail plate interfering with nail bed access, and the difficulty in finding compounds with adequate pharmacologic profile for nail penetration. Aim of Study: To assess prevalence of onychomychosis and risk factors associated with carpet industry workers. Patients and Methods: A comparative cross sectional study was conducted between March 2021 to March 2022 among 65 workers from carpet manufacturing set in 10th of Ramadan city, which was selected randomly out of total three factories in the city and a comparison group of matched administrative workers. Diagnosis of cases and evaluation of therapeutic response was done by onychomycosis severity index score. Potassium hydroxide microscopy and culture were performed at baseline and at the end of the study. Results: Prevalence of onychomychosis among exposed workers was 24.6% versus 3.3% among controls (general population) (p<0.001), 75% of exposed workers had multiple fingernails OM, 50% of them had candidal onychomycosis (CO) and 31.3% proximal subungual onychomycosis (PSO), while the two cases of controls had single toenail distal and lateral subungual onychomycosis (DLSO). Old age found to be significant among onychomycosis (OM) cases, all OM cases involved in wool fibers washing and processing (56.3%) or yarn dying (43.7%) versus 8.2% and 10.2% respectively of non-infected group. Risk factors included prolonged hand immersion in water (62.5%), history of previous treatment (31.3%), and exposure to irritating chemicals and detergents (37.5%), that were statistically significant among studied cases.
Conclusions: Onychomycosis is a common health problem among carpet weaving workers, especially manual workers due to wet processes and exposure to chemical dyes without using PPE, so protective measure should be taken after treat-ment of the problem.