Naildex: Pilot evaluation of an onychodystrophy severity instrument

Erin M. Warshaw, Carmen A. Traywick, Allison A. Hoffman, Kia K. Lilly, Rebecca L. Koshnick, Janet W. Robinson, Pitiporn Suwattee, Jovonne K. Foster, Suephy C. Chen

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


A valid and reliable measure that captures onychodystrophy disease severity is important for both clinical and research applications. Three hundred and twenty-two patients at two Veterans Affairs Medical Centers with clinical evidence of onychodystrophy suggesting onychomycosis (at least 25% in a distal subungual pattern) were examined using Naildex parameters. Naildex scores were calculated by a combination of: per cent of each nail infected, area of each nail and number of infected nails. Patients also completed a nail-specific quality of life questionnaire (NailQoL) and nail samples were collected and examined mycologically. Data was analysed for all enrolled patients (n = 322) and patients with mycologically-confirmed onychomycosis (n = 243). Inter-rater reliability was calculated from two examiners who each evaluated 17 patients with mycologically-confirmed onychomycosis. Significant correlations (P < 0.01) between Naildex and NailQoL as well as proxy measures (duration of infection) indicated construct validity of the instrument for all patients as well as mycologically-confirmed cases. Strong correlation (r = 0.754, P < 0.01, n = 17) indicated high inter-rate reliability. This pilot evaluation suggests that Naildex is a valid and reliable measure of onychomycosis severity.

Original languageEnglish (US)
Pages (from-to)14-20
Number of pages7
Issue number1
StatePublished - Jan 2008


  • Onychodystrophy
  • Onychomycosis
  • Severity


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