Naildex score and onychomycosis

Dear Editors:

I read the recent publication by Yegneswaran Prakash et al¹ on Naildex score and onychomycosis with a great interest. I have some points for discussion. Yegneswaran Prakash et al concluded that “The Naildex scoring method is rapid and inexpensive and may have a significant role for testing new drugs in clinical trials and also may be used to assess the response to treatment of onychomycosis”¹. However, this work studied few subjects and there is no complete report on the diagnostic value of the scoring system (sensitivity, specificity, accuracy, etc.). Also, there was no cost analysis to support that this test is inexpensive or cost effective. Whether the scoring system is user-friendly or not is still questionable.