Introduction
Since the beginning of mankind, the instinctive desire for beauty has evolved in various ways, which has culminated in today's beauty culture. Humans spare no expense or time in enhancing their physical appearance, and the importance of the outward image has surpassed that of inner beauty and attitude, which were previously considered crucial. As a result, one's perception of success and social standing has shifted. In particular, taking care of one's appearance has become a form of stress reduction and a means of expressing individuality. Beauty care is also viewed as an external means of displaying confidence and making a good impression in interpersonal relationships (Jung & Moon, 2018). With the acceleration of industrialization and economic growth, the social activities of women have increased, which has led to improved income levels and social status. Consequently, the desire and interest in beauty have been increasing. Specialized care has included not only the hair and face but also the hand and foot (Kim et al., 2010). The beauty industry is diversifying to improve and supplement physical health by expanding its concepts to health and beauty management with a focus on overall well-being that exceeds simple aesthetics (Kwak et al., 2012).
In many developed countries, the prevalence of toenail problems is high due to urbanization and increased social activities. The underlying reasons are related to various activities such as sports and tourism (Nowicka & Nawrot, 2021). The management of problematic toenail among men is also becoming increasingly prevalent. Women's progress in society, increased emphasis placed on physical appearance, and men’s increased interest in beauty contribute to a cultural climate that values personal health, youthfulness, and overall well-being. This trend is not only influencing personal lives but also medical trends. As such, hospitals also offer nail care services apart from the extensive care provided by beauty nail care services due to this phenomenon. The expansion of professional procedures performed in hospitals is driving the growth of the healthcare market (Lee et al., 2015). Medical nail care refers to a combination of medical treatment and corrective care provided by a specialist after diagnosis. If treatment or care alone is unsatisfactory, then the achievement of rapid treatment effects for problematic nails can be considered professional management (Pyo et al., 2007).
Recently, as interest in nail diseases that lead to continued problems in the Republic of Korea has increased, the need for nail care using auxiliary methods for treatment has emerged, and medical nail care systems that combine treatment and cosmetic procedures have been increasing.
Medical nail care is conducted using medical devices, such as lasers and corrective care, in dermatology clinics or hospitals. It can be defined as a scientific approach for analyzing and treating nail problems and conditions (Jung, 2009). The difference between medical nail care and nail salon care is that medical nail care is part of a hospital treatment process. In dermatology hospitals, these cosmetic procedures are performed in various forms (Lee, 2021). Treatment in relation to beauty and care includes drill care, noninvasive wire brace, acrylate, resin gel, and Fraser, among others. Currently, many hospitals complementary therapies before and after treatment for onychomycosis, ingrown nail, and pincer nail. Currently, the market for medical nail care requires various strategies for identifying the needs of consumers, establishing long-term relationships, and developing sustainable services to support treatment. This scenario will soon become a crucial factor in the competitiveness of medical care (Yang & Jeong, 2013; Eyuboglu & Buja, 2007).
Previous studies on problematic toenails were only conducted to examine the efficacy of cosmetic (Márquez-Reina et al., 2020; Liu & Huang, 2018) or medical (Ma et al., 2019) treatment. However, studies that analyze and document differences in the usage characteristics of consumers of medical nail care that combines the two treatments are lacking. To address this research gap, the current study analyzed such characteristics on the basis of a system that includes medical treatment with noninvasive cosmetic correction, which is a feature of the Korean medical nail care system. As an initial study on medical nail care, this study is significant in that it identifies usage characteristics by gender and provides a basis for understanding consumers and rethinking the merged management system of medical and beauty.
Methods
1. Participants and data collection
As a study on the usage characteristics of consumers with problematic nail diseases experiencing medical nail care, this study produced and distributed a self-questionnaire using Naver from December 15 to December 21, 2022. The questionnaire was distributed to hospitals that introduced a problematic nail care system. Data from a total of 500 respondents were collected. Among them, 31 were excluded due to missing data, such that 469 were included in the final analysis.
2. Usage characteristics
To analyze the utilization characteristics, 8 questions were reconstructed and measured for this study based on the study of medical utilization characteristics in the study (Kim, 2015), referring to the treatment target, subjective health level, and duration of treatment use. The survey was conducted by presenting pictures along with the names of the treatments to enable the participants to could accurately distinguish the type of care they received. Noninvasive treatment procedures that have been performed in the existing hospitals, which include medication, high-frequency, Fraser, Onycho Clip and stiring. Noninvasive correction and care options that have been added to medical nail care include drill care, noninvasive wire brace, resin gel, and acrylic.
3. Data analysis
Statistical data were analyzed using SPSSWIN ver. 28.0 (SPSS Inc., USA), and frequency analysis was conducted to elucidate general and treatment use characteristics. Moreover, the chi-square test (χ2 test) was performed to verify that the characteristics of treatment use displayed significant differences according to the general characteristics of consumers and procedures received for onychomycosis treatment and the improvement of ingrown and pincer toenails. However, treatments may overlap during the treatment process, which were measured as multiple responses.
Results
1. General characteristics of the participants
Table 1 presents the results of frequency analysis of the general characteristics of the participants. In terms of gender, men and women comprise 34.1% and 65.9% of the sample aged in their 20s (20.5%), 30s (33.5%), 40s (26.0%), and 50s or older (20.0%). The highest level of education noted is bachelor's degree (72.5%) followed by high school (14.9%), and master's degree (12.6%). According to vocation, 4.7%, 14.3%, 39.4%, 14.9%, 15.8%, 8.3%, and 2.6% are students, professionals, office workers, service workers, home makers, business owners, and other, respectively. The study classified marital status as unmarried (39.0%), married (59.1%), and other (1.9%). Monthly average income reached less than 2 million won (4.3%), 200-2.99 million (16.6%), 300-3.99 million (34.1%), 400-4.99 million (20.3%), and more than 5 million won (24.7%). The residential areas of the respondents included Seoul (28.6%), Gyeonggi-do (27.9%), Gyeongsang Province (27.3%), Chungcheong Province (6.6%), Jeolla-do (6.4%), and Jeju and Gangwon (3.2%).
2. Types of problematic toenail and status differences
Table 2 presents the results of the analysis of differences in usage characteristics according to the types of problematic toenail. The study found a significant difference in the ratios corresponding to onychomycosis (χ2=15.437, p<0.001) and pincer toenail (χ2=4.004, p<0.05). The frequency of onychomycosis was 56.9% for men, and the frequencies of ingrown and pincer toenails were 44.3% for women, which is considered high. In terms of current toenail conditions, 51.3% and 46.0% of the men and women, respectively, demonstrated the rate of 'slightly bad' without a significant difference.
3. Differences in facilities that provide medical nail care
Table 3 depicts the differences in facilities that provide medical nail care. The study noted a significant difference in previous management facilities (χ2=18.573, p<0.01) in which demonstrated high rates of visiting hospitals (43.1%), whereas the women tended to opt for home management (32.4%). The ratio of nail salon care was higher for women (17.5%) than that for men (5.6%), which is a significant difference (p<0.01).
The reasons for using medical nail care led to high rates of improvement in nail problems for men (40.6%) and women (39.2%) without a significant difference.
4. Analysis of differences in treatment of problematic toenails
Table 4 lists the differences in the treatment of problematic toenails. In terms of proportion, 51.3% and 37.5% of the men and women underwent procedures received to treat onychomycosis but displayed a significant difference in medication (χ2=8.122, p<0.01). Along with medication, the men and women exhibited high ratios of laser use (χ2=9.635, p<0.01) and other procedures (χ2=6.640, p<0.05), respectively, which demonstrated a significant difference. In terms of procedure, 44.4% of the men received ingrown nail treatment to improve pincer toenail, and 38.2% of the women mainly used drill care. The rate of use of the resin gel procedure (χ2=12.171, p<0.001) was relatively higher for women (20.7%) than that for the men (8.1%), which indicates a significant difference.
5. Expenditure and effectiveness
Table 5 presents differences in expenditure and effectiveness in which 43.1% of the men and 51.8% of the women reported monthly expenses of less than 100,000 won without a significant difference (p>0.05). For the duration of the effect, 35.6% of the men and 30.4% of the women produced ratios of less than 2-3 months, which indicates no significant difference.
Discussion
This study examined the usage characteristics of customers with problematic toenail diseases by conducting a survey on 469 customers who received or are currently receiving medical nail care.
Table 2 presents the result of the comparison of the percentages of variables that displayed significant differences according to gender.
Onychomycosis (χ2=15.437, p<0.001) displayed a significant difference for a high proportion of men (56.9%). Pincer nails (χ2=4.004, p<0.05) received a high percentage for women (21.4%). Scholars demonstrate that infection in men is related to various activities such as sports. In particular, it is very common in athletes, marathons, swimmers, and a few groups of professionals. Moreover, it can be contacted in public places such as swimming pools, gyms, and shower rooms, which play an important role in spreading infections. Enclosed shoes worn while exercising also promote the growth of fungus and the subsequent development of ringworm (Seebacher et al., 2008; Havlickova et al., 2008). On this basis, the study assumed that these factors trigger the development of athlete's foot in men. Lee et al. (2011) conducted a study on pincer nails and found that women exhibited higher symptom rates, which support the current study. The reasons for the more frequent symptoms of women include obesity, inappropriate cutting of the nail plate, and tight shoes (Baran, 2001). Moreover, another consideration is the unique features of women's shoes (high heels), which can also be considered a triggering factor.
The study observed a significant difference in previous management facility (χ2=18.573, p<0.01), as the rate of men opting for management in facilities was high, whereas the rate of home management was high for the women. This result is considered to support the results of this study. Specifically, the men disclosed that they were not embarrassed to face a foot specialist, while women responded that they were embarrassed (Ratajczak et al., 2022). Beuscher & Kelechi (2019) mentioned that many patients delay treatment until the symptoms of the infection worsen, because they misunderstand that if they consider their condition as simply a cosmetic problem, then it will be solved without treatment (Beuscher & Kelechi, 2019). Therefore, we believe that this study supports our findings.
The proportion of men who underwent laser or drug treatment to address toenail fungus was higher. This study found that the symptoms of toenail fungus are high in men, which confirms the abovementioned results. The typical treatment for toenail fungus is oral medication. However, side effects, such as liver or kidney damage, may occur due to medication. Alternatively, laser is a treatment method with less reported side effects and is easy to apply compared with drug treatment (Ortiz et al., 2014; Galvan Garcia, 2014). Therefore, the study infers that laser treatment was combined with medication to increase treatment efficacy (Daye & Durmaz, 2021). The use of resin gel treatment (χ2=12.171, p<0.001) to improve ingrown and pincer toenails was relatively higher for women (20.7%) compared with men (8.1%). The study infers that women consider aesthetic satisfaction more important in terms of problematic toenail procedures. Moreover, women acquire more information about beauty care than men do. The study by Lee also demonstrated that gel care is a quick procedure, poses no side effects, and is aesthetically pleasing. Therefore, the results are supported (Lee & Kwon, 2022).
In summary, in terms of the type of problematic toenail, men exhibited high rates of onychomycosis (56.9%), and women achieved a high rate of pincer toenail (21.4%). A total of 43.1% of the men used hospitals or were later prescribed laser procedures (28.8%) and medication (51.3%) when problems such as onychomycosis were observed. Women frequently opted for home management (32.4%). However, combining the ratio if the use of nail shops (17.5%) and problem-oriented management facilities (21.0%), the study proposes that the usage characteristics of consumers are derived not only from the perspective of treatment but also care. In terms of the care aspect, the study found that women used highly wearable care procedures such as resin gel (20.7%), noninvasive wire brace (20.7%), and acrylic (12.9%), which are widely used in cosmetic procedures for ingrown nail care to eliminate heterogeneity and increase aesthetics.
Conclusion
1. Consumer considerations
The men and women responded that the rate of improvement of problematic nail diseases was high due to their use of the current medical nail care. In other words, the treatment was activeness. Moreover, given that the use of drill care was commonly high in terms of drug treatment and noninvasive correction in terms of treatment, the result reflects the advantages of combined treatment. Moreover, drill care was recognized as an effective form of basic care in the treatment process. Men are less hesitant to visit hospitals due to reluctance or shame compared with women, such that men should be encouraged to actively use the treatment system in hospitals to increase the effectiveness of the treatment. In the case of women, treatment, basic care, and noninvasive corrective treatment can be used to increase the aesthetics aspect to encourage consumers to continue the treatment process.
2. Potential of medical nail care and limitations of the research
The medical nail care system addresses problematic nails using medical and noninvasive corrective treatments. Nevertheless, many hospitals continue to reject this system. Thus, patients are burdened with invasive treatment due to cosmetic problems, and satisfaction with treatments may decrease if they do not feel an intuitive effect (Daye & Durmaz, 2021). The need for this system can increase profits for hospitals if they practice various treatment options. From the point of view of patients, selecting from various treatment options according to their lifestyle is easy. Examining the trend of research on problematic nails, the study found a few articles on the efficacy of noninvasive preservation care (Márquez-Reina et a., 2020; Liu & Huang, 2018) or medical treatment (Ma et al., 2019), Although other studies depict the effects of treatment and correction, those that document the analysis of consumer usage characteristics of medical nail care systems that combine hospital treatment and noninvasive correction care are lacking. Thus, to the best of our knowledge, the current study is the first to conduct a survey on consumers and their use of noninvasive combination therapy, which differs from previous studies and is considered to poses an academic value. The results that if a combined treatment system of cosmetic correction and medical treatment can be considered, then patients may select options that they deem best. In addition, we provided basic data for analysis according to gender and for broadening the base in connection with medical as proof of the need for cosmetic correction.
The medical nail care system in the Republic of Korea is in its infancy, such that the study the number of respondents is limited, and all treatment options in hospitals cannot be generalized. Therefore, future studies are required to classify and analyze treatment usage characteristics and evaluate consumer satisfaction.
