‘Open Toe Sandals Syndrome‘ was first proposed in the 2016 Christmas edition of the British Medical Journal. The Christmas editions of the BMJ are well known for some off-beat research. The authors, from the Public Health England National Mycology Reference Laboratory in Bristol, UK noticed seasonal variations in the number samples for dermatophytes sent to the laboratory for analysis. Upon analysis, they found that the seasonal variation was almost all accounted or by the sending of toenail specimens, with skin and hair samples remaining consistent with no seasonal variations.
The authors proposed three hypotheses for the seasonal variations:
- A real increase in infections at this site, possibly due to greater use of communal sports facilities early in the year, which we termed “post Christmas indulgence gym syndrome” (PCIGS)
- An increased awareness of pre-existing genuine fungal infections of toenails as the summer approaches and feet are bared, or “Oh no, look at those syndrome” (ONLATS)
- An increased fear that slightly disfigured toenails visible with summer footwear might be the results of dermatophyte infection, or “open toe sandals syndrome” (OTSS)
The authors most strongly suggest that the cause of the dramatic increase in toenail sampling in spring to late summer is most likely due to the increased use of open toe sandals in the warmer months. Obviously, it is the unsightly appearance of the toenails is the trigger for seeking medical advice for the onychomycosis.
Subsequent to the above report, another comment in the BMJ confirmed this with an increase in prescribing data for oral terbinafine and amorolfine nail laquer in the summer months, confirming this seasonal variation.
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