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Background: Tinea capitis is an infectious dermatosis frequent in children, causative fungi variable over time and space. The risk factors associated with this disease are still poorly understood. The objective of this study was to estimate the prevalence of tinea capitis among schoolchildren in Lomé (Togo), identify the fungal species involved and assess the associated risk factors. Patients and Methods: It was a cross‐sectional and case–control study conducted in primary schools in Lomé from November 2020 to April 2021. All pupils presenting tinea capitis suspected lesions have been sampled, and the scraping and hair were examined by direct microscopy in KOH solution and cultured in Sabouraud dextrose agar with chloramphenicol and cycloheximide. Positive children were matched by age and sex with those without symptoms for case–control study. Results: Out of the 15,087 pupils enrolled, 465 had positive cultures for dermatophytes, corresponding to the tinea capitis prevalence of 3.08% (95% CI [2.59–3.57]). Trichophyton mentagrophytes (81.86%) and Trichophyton soudanense (13.12%) were the majors isolated dermatophytes. The risk factors were mostly living in households with domestic animals, showering less than twice a day, having a history of ringworm, having similar lesions in the same household and sharing personal hygiene items. Conclusion: This study highlights the low prevalence of tinea capitis in schoolchildren in Lomé (Togo), the causative species dominated by T. mentagrophytes and emphasises the importance of environmental and behavioural factors in the mycosis transmission. Implementing preventive measures addressing the identified factors could help to reduce the prevalence of this disease. [ABSTRACT FROM AUTHOR]

Background: Dermatophytosis, caused by dermatophytes, affects up to 25% of people globally, with higher rates observed in Africa and Asia. While these infections are usually superficial, they can become severe in immunocompromised individuals. Despite their high prevalence, scientific research on dermatophytes is limited and the epidemiological data available are insufficient. In addition, diagnostic methods are not standardised and there are challenges with resistance to antifungals. Objectives: This study aimed to conduct a bibliometric analysis of scientific publications related to dermatophytes and dermatophytosis to assess research output and trends. Methods: A bibliometric analysis of publications from 2000 to 2023 in Web of Science and Scopus examined trends, citation counts, publication types, key journals, top authors and institutions and funding sources. Results: The analysis revealed a significant increase in dermatophyte‐related publications, with 15,868 articles retrieved from the Web of Science and 23,189 from Scopus. Research articles dominated the output, constituting 76.2% in Web of Science and 80% in Scopus. Peak publication years were 2019, 2021 and 2022 in Web of Science, and 2020, 2021 and 2023 in Scopus, with lower output between 2000 and 2002. The United States and India were the leading contributors, followed by Brazil and China, though citation metrics varied. Although there has been a rise in the number of publications, the amount of research conducted on dermatophytes is still very limited in comparison with other types of fungal diseases. Conclusions: Dermatophyte‐related research has increased over the past 2 decades. However, research gaps remain, particularly compared with other fungal diseases. Advances in diagnostics, antifungal testing and taxonomic classification are urgently needed. The study underscores the need for continued research and global collaboration to address these issues. [ABSTRACT FROM AUTHOR]

Background: Tinea pedis is one of the most prevalent superficial fungal infections. Initial antifungal treatment is often acquired over‐the‐counter (OTC) without previous consultation with a physician. Objective: Lately, increasing antifungal terbinafine resistance has been documented in Denmark and globally and it is therefore of interest to assess how Danish pharmacies advise customers with tinea pedis. Methods: One hundred Danish pharmacies were randomly selected and an employee interviewed from each. A structured question guide was followed, with the possibility to add further comments. Results: Interviews of 94 pharmacies were conducted. Six pharmacies never replied. Terbinafine as standard dose or cutaneous solution terbinafine one time application (Lamisil Once (R)) were recommended by 99% of the pharmacy employees as first‐line treatment. The customer was advised to seek medical attention when tinea pedis was recurring (93%), or when treatment duration was > 2 weeks (77%). The majority (88%) of the pharmacy employees had no knowledge about antifungal resistance. Conclusion: Only few pharmacy employees were aware of the current problem of antifungal resistance and the majority advised costumers to initiate treatment using OTC topical terbinafine. The problem of emerging antifungal resistance requires attention in order to provide customers with tinea pedis effective treatment and prevent further societal spread of resistance to antifungals. [ABSTRACT FROM AUTHOR]

Introduction: Equal access to medicines is crucial to ensuring public health, but access is difficult to measure, especially for infections where changes in infective species make treatment choices highly dynamic. This study investigated if the combination of infection prevalence with medicine efficacy and regulatory availability could access medicines access of topical onychomycosis medicines. Methods: Two databases, PubMed and Web of Science, were used to identify relevant information published between 1990 and 2019. For the meta‐analysis, human onychomycosis investigations using PCR analysis were included. Reviewers independently selected eligible articles, extracted data and assessed the study quality. A random‐effects meta‐analysis model with a Freeman–Tukey transformation was employed to the PCR data. For the meta‐analysis, the global infection trends and regional differences in the infective organisms were determined. Results: Of the 26 studies analysed, the PCR analysis in 18 studies confirmed onychomycosis in about half of the visually suspected cases (55%, CI 43%–67%). Across all 26 studies dermatophytes were the most prevalent infective organism (57%, CI 37%–76%), but a sub‐group analysis showed yeasts predominated in females (31%, CI 0%–84%) (p < 0.0001), in fingernail infections (42%, CI 21%–65%) (p < 0.0001) and in arid countries (p < 0.0001). Combining these results with medicine efficacy data showed that residents from 83 of the 92 countries assessed (90%) could not access the most efficacious topical product, and 22% could not access any broad‐spectrum agents. Countries in Africa had the poorest access to topical onychomycosis medicines. Conclusion: This study identified that access to effective topical products for onychomycosis is a global problem. This issue appeared to be due to under‐representation of candida infections in pivotal clinical studies of topical onychomycosis products. A head‐to‐head multicentre study for topical efinaconazole or a novel broad spectrum topical agent is needed to help resolve these access problems. Protocol Registration: PROSPERO—CRD42023464744 [ABSTRACT FROM AUTHOR]

Background: Fungi clinically relevant to human skin comprise prevalent commensals and well‐known pathogens. Only rarely human skin harbours fungi that evade identification. Objective: To characterise an enigmatic specimen isolated from a skin lesion. Methods: A comprehensive clinical and mycological workup including conventional methods for phenotypic characterisation and sequencing based on internal transcribed spacer (ITS) and large subunit (LSU) regions to infer a phylogenetic tree. Results: Cultures on common solid media were macroscopically inconspicuous initially until mycelial tufts developed on the surface, notably on potato dextrose agar. Polymorphous chlamydospores were detected but no aleurospores and ascomata. At 26°C, the isolate grew on standard agars, plant materials and garden soil and utilised peptone, keratins, lipids, inulin, erythrocytes and cellulose. It also grew at 5°C and at 37°C. Nucleotide sequences of its ITS region showed 93% similarity to sequences of different Malbranchea species. The closest matches among LSU rRNA sequences were obtained with the genera Amauroascus, Arthroderma, Auxarthronopsis and Malbranchea (93%–95%). A combined phylogenetic analysis placed the fungus in a sister clade to Neogymnomycetaceae, classified as incertae sedis in Onygenales, on a large distance to either Diploospora rosea or 'Amauroascus' aureus. Conclusions: The genus Inopinatus gen. nov. (MB854685) with the species Inopinatus corneliae sp. nov. (MB854687) is introduced to accommodate our isolate (holotype: DSM 116806; isotypes: CBS 151104, IHEM 29063). Probably Inopinatus corneliae is a geophilic species that, although potentially harmful, was no relevant pathogen in our case. Its ecology, epidemiology and pathogenicity need to be further clarified. [ABSTRACT FROM AUTHOR]

The article discusses a case report on the successful treatment of tinea capitis caused by Trichophyton rubrum in a patient with autoimmune chronic hepatitis using daylight photodynamic therapy with BF‐200 ALA combined with topical terbinafine. The standard treatment for tinea capitis involves systemic antifungal medications, but in this case, systemic antifungals were contraindicated due to the patient's liver condition. The combination of photodynamic therapy with oral antifungal medications showed improved treatment efficacy, leading to complete resolution of the infection in the patient. The treatment was well-tolerated, and the patient remained in remission 15 months after the therapy. [Extracted from the article]

Background: Kerion is a severe type of tinea capitis that is difficult to treat and remains a public health problem. Objectives: To evaluate the epidemiologic features and efficacy of different treatment schemes from real‐world experience. Methods: From 2019 to 2021, 316 patients diagnosed with kerion at 32 tertiary Chinese hospitals were enrolled. We analysed the data of each patient, including clinical characteristics, causative pathogens, treatments and outcomes. Results: Preschool children were predominantly affected and were more likely to have zoophilic infection. The most common pathogen in China was Microsporum canis. Atopic dermatitis (AD), animal contact, endothrix infection and geophilic pathogens were linked with kerion occurrence. In terms of treatment, itraconazole was the most applied antifungal agent and reduced the time to mycological cure. A total of 22.5% of patients received systemic glucocorticoids simultaneously, which reduced the time to complete symptom relief. Furthermore, glucocorticoids combined with itraconazole had better treatment efficacy, with a higher rate and shorter time to achieving mycological cure. Conclusions: Kerion often affects preschoolers and leads to serious sequelae, with AD, animal contact, and endothrix infection as potential risk factors. Glucocorticoids, especially those combined with itraconazole, had better treatment efficacy. [ABSTRACT FROM AUTHOR]

Background: Tinea faciei is a relatively uncommon dermatophyte infection. The studies, which included clinical forms, and isolated species of dermatophytes, are limited. Materials and Methods: This retrospective study aims to determine the causative organism, clinical characteristics, treatments and outcomes of patients with tinea faciei attending the dermatologic clinic, Siriraj Hospital, from 1 January 2017 to 30 September 2021. Demographic data, clinical presentations, isolated dermatophyte species, treatments and outcomes were collected and analysed. Results: A total of 151 tinea faciei cases were observed. Trichophyton rubrum (48.6%), Trichophyton mentagrophytes complex (22.2%) and Microsporum canis (18.1%) were common causative agents. Tinea faciei was commonly detected in females (64.9%) with a history of pets (54.6%). Clinical presentations often involved plaques and scales on the cheeks. Among patients with lesions on the cheek, mycological cure was observed significantly less often compared to those without cheek lesions. Patients with other concurrent skin or nail infections, a history of topical steroids and a history of previous fungal infection had a slightly longer duration of mycological cure than those without factors. Recurrent infection was found in 33.3%. Male, history of previous fungal infection, and lesions on the cheeks were significantly associated with recurrent infection. Conclusions: Fungal infection of the face was commonly found in women and patients with pets. The most common pathogen that caused tinea faciei was T. rubrum. Topical antifungal treatments could be used with favourable outcomes. The history of past infection and lesion on the cheeks should be carefully assessed to be vigilant for recurrent infection. [ABSTRACT FROM AUTHOR]

Background: Tinea faciei, a specific dermatophytosis that affects the glabrous skin of the face, not only causes physical discomfort but also leads to greater psychological distress. Tinea faciei is a public health concern. Objectives: To analyse the epidemiological characteristics, responsible dermatophyte species and clinical features of tinea faciei in Hangzhou. Methods: Data were obtained from the Laboratory Information System of the Mycology Laboratory and Medical Information System at a hospital in Hangzhou. Isolates were identified based on their macroscopic appearance and microscopic morphology. Results: Tinea faciei was diagnosed in 701 patients, involving 359 males and 342 females, aged between 2 months and 97 years. In total, 499 isolates (71.18%) were identified as Trichophyton rubrum. Anthropophilic isolates were identified in 297 (82.73%) males and 207 (60.53%) females (p <.01). Among patients with anthropophilic dermatophytes infection, 447 (88.69%) were adults. Zoophilic dermatophytes were isolated in 57 (15.88%) males and 130 (38.01%) females (p <.01), among whom 108 (57.75%) were children. Conclusions: Anthropophilic dermatophytes, especially T. rubrum, were the predominant cause of tinea faciei, while zoophilic dermatophytes were the most prevalent in children. Compared with men, women may be more susceptible to zoophilic dermatophytes. [ABSTRACT FROM AUTHOR]

Background: The skin barrier is vital for protection against environmental threats including insults caused by skin‐resident microbes. Dysregulation of this barrier is a hallmark of atopic dermatitis (AD) and ichthyosis, with variable consequences for host immune control of colonizing commensals and opportunistic pathogens. While Malassezia is the most abundant commensal fungus of the skin, little is known about the host control of this fungus in inflammatory skin diseases. Methods: In this experimental study, MC903‐treated mice were colonized with Malassezia spp. to assess the host–fungal interactions in atopic dermatitis. Additional murine models of AD and ichthyosis, including tape stripping, K5‐Nrf2 overexpression and flaky tail mice, were employed to confirm and expand the findings. Skin fungal counts were enumerated. High parameter flow cytometry was used to characterize the antifungal response in the AD‐like skin. Structural and functional alterations in the skin barrier were determined by histology and transcriptomics of bulk skin. Finally, differential expression of metabolic genes in Malassezia in atopic and control skin was quantified. Results: Malassezia grows excessively in AD‐like skin. Fungal overgrowth could, however, not be explained by the altered immune status of the atopic skin. Instead, we found that by upregulating key metabolic genes in the altered cutaneous niche, Malassezia acquired enhanced fitness to efficiently colonise the impaired skin barrier. Conclusions: This study provides evidence that structural and metabolic changes in the dysfunctional epidermal barrier environment provide increased accessibility and an altered lipid profile, to which the lipid‐dependent yeast adapts for enhanced nutrient assimilation. Our findings reveal fundamental insights into the implication of the mycobiota in the pathogenesis of common skin barrier disorders. [ABSTRACT FROM AUTHOR]

Background: Dermatomycoses count to the most frequent dermatoses in Cambodia. Objectives: The aim of this survey was to investigate the occurrence of dermatophytes in this Southeast Asian country. Methods: From June 2017 to July 2018, skin scrapings were taken from 67 patients with superficial dermatophytosis for mycological diagnostics. Identification of dermatophytes was confirmed by sequencing of the 'internal transcribed spacer'—(ITS) region of the rDNA, and the gene of the Translation Elongation Factor (TEF)‐1α. Results: Patients were suffering from tinea corporis and tinea inguinalis/cruris 42/67 (63%), tinea capitis/faciei 14/67 (21%), tinea corporis/capitis/faciei 6/67 (9%), tinea manuum/pedis 2/67 (3%), tinea pedis 2/67 (3%) and tinea manuum 1/67 (1%). Both, by culture and/or PCR, a dermatophyte was detected in 52 (78%) out of 67 samples. Culture positive were 42 (81%) of 52, PCR positive were 50 (96%). The following dermatophytes were found: Trichophyton (T.) rubrum, 36/52 strains (69%, 29 by culture), T. mentagrophytes/T. interdigitale (TM/TI) 9/52 (17%, six by culture) and Microsporum (M.) canis 5/52 strains (10%, by culture). One strain of Nannizzia (N.) incurvata 1/52 (2%) and N. nana 1/52 (2%) was isolated. Based on sequencing, we demonstrated that two T. mentagrophytes strains out of the nine TM/TI represented the new ITS genotype XXV Cambodia. We found one T. mentagrophytes strain genotype VIII (now, reclassified as T. indotineae). This isolate was terbinafine resistant, and it exhibited the amino acid substitution Phe397Leu in the squalene epoxidase. Three strains of T. interdigitale genotype II* were isolated. Conclusion: This is the first survey on epidemiology of dermatophytes in Cambodia. Currently, T. rubrum represents the most frequent species in Cambodia. One Indian strain genotype VIII T. mentagrophytes was found. A highlight was the first description of the new T. mentagrophytes genotype XXV Cambodia. [ABSTRACT FROM AUTHOR]

A growing body of literature has marked the emergence and spread of antifungal resistance among species of Trichophyton, the most prevalent cause of toenail and fingernail onychomycosis in the United States and Europe. We review published data on rates of oral antifungal resistance among Trichophyton species; causes of antifungal resistance and methods to counteract it; and in vitro data on the role of topical antifungals in the treatment of onychomycosis. Antifungal resistance among species of Trichophyton against terbinafine and itraconazole--the two most common oral treatments for onychomycosis and other superficial fungal infections caused by dermatophytes--has been detected around the globe. Fungal adaptations, patient characteristics (e.g., immunocompromised status; drug-drug interactions), and empirical diagnostic and treatment patterns may contribute to reduced antifungal efficacy and the development of antifungal resistance. Antifungal stewardship efforts aim to ensure proper antifungal use to limit antifungal resistance and improve clinical outcomes. In the treatment of onychomycosis, critical aspects of antifungal stewardship include proper identification of the fungal infection prior to initiation of treatment and improvements in physician and patient education. Topical ciclopirox, efinaconazole and tavaborole, delivered either alone or in combination with oral antifungals, have demonstrated efficacy in vitro against susceptible and/or resistant isolates of Trichophyton species, with low potential for development of antifungal resistance. Additional real-world long-term data are needed to monitor global rates of antifungal resistance and assess the efficacy of oral and topical antifungals, alone or in combination, in counteracting antifungal resistance in the treatment of onychomycosis. [ABSTRACT FROM AUTHOR]

Background: Tinea capitis (TC), a fungal infection that occurs in children, is primarily caused by dermatophytes such as Trichophyton and Microsporum species. For Trichophyton species, treatment with terbinafine is considered more effective than griseofulvin treatment. Specific populations, such as refugee children, are more susceptible to TC. Objective: This study aimed to describe and compare the response to treatment among Israeli and refugee children with TC. Patients/Methods: We retrospectively reviewed data collected on refugee and Israeli children with TC between January 2004 and January 2020. Results: Overall, 3358 children with TC (refugees: 1497; Israelis: 1861) were identified. Among these, 86% of the refugee children had TC caused by Trichophyton violaceum, 65% of the Israeli children had TC caused by Microsporum canis and 83% of all children were treated with griseofulvin. Overall, 14% of the refugees showed a partial response to a griseofulvin dose of ≤25 mg/kg/day; however, they showed a complete response upon increasing the dose to ≥30 mg/kg/day. No significant adverse effects were observed. Conclusion: The over‐crowded day care centres and dense living make refugee children more susceptible to TC than the general population, and griseofulvin dosage adjustment is necessary. TC, due to Trichophyton species, could benefit from receiving an increased dose of griseofulvin in a suspension form, which is cheaper than terbinafine. [ABSTRACT FROM AUTHOR]

Background: Onychomycosis is a common nail infection caused by dermatophytes, nondermatophytes molds (NDM), and yeasts. The prevalence of Aspergillus spp. is increasing worldwide. This study aims to describe the epidemiological and microbiological features of onychomycosis, especially for Aspergillus spp. Methods: This is a 5‐year retrospective study of clinically suspected onychomycosis in one microbiological clinic in Albania. The mycological examination, which included direct microscopic examination of nail scrapings with 20% KOH and culture, was performed on 411 patients. After incubation, we studied the macroscopic characteristics of the colonies, size, shape, and color, and their microscopic examination. We evaluated positive cases for Aspergillus, all cases where Aspergillus was grown in the culture, the microscopy was positive, and the culture was negative for dermatophyte. Results: Onychomycosis resulted positive in 267 patients (52.9% females vs. 47.1% males). A total of 62.2% resulted infected by dermatophytes, 29.6% by yeasts, and 8.2% by NDM. Onychomycosis resulted more frequent in the age group 15–64 years old (63%). Aspergillus spp. were found in 19 patients from 22 patients with NDM onychomycosis. Males (11 patients) and the age group 15–64 years old (14 patients) were more vulnerable to Aspergillus spp. A. niger, A. flavus, and A. terreus isolated from the nail cultures in our study. The culture resulted more superior to KOH examinations. Conclusions: Our study indicates that NDM, including Aspergillus spp., are still rare findings from fungal examinations. However, dermatologist's clinical suspicion and microbiologist's skills are mandatory in diagnosing and properly managing patients with Aspergillus spp. [ABSTRACT FROM AUTHOR]

Background: Numerous reports of resistance to terbinafine in Trichophyton spp. from all over the world are arousing justified attention and concern. Point mutations in the gene that encodes the squalene epoxidase (SQLE) enzyme are responsible for these therapeutic resistances. Objectives: Primary objective of the study was to describe first isolates of Trichophyton spp. resistant to terbinafine among the patients treated between September 2019 and June 2022 at the Dermatology Units of Ospedale Maggiore Policlinico and San Bortolo Hospital. Secondary objective was to study the resistance mechanism. Methods: Patients with confirmed Trichophyton spp. infection has been treated with systemic and topical terbinafine. Patients were then re‐evaluated 12 weeks after the therapy. Patients with incomplete or absent response to terbinafine underwent a new skin scraping for direct mycological examination, new identification of dermatophyte species from culture and MALDI‐TOF, molecular species identification, antifungal susceptibility testing and molecular analysis of SQLE gene. Results: We identified five patients without clinical response to treatment with terbinafine. The DNA sequencing of the ITS region identified one Trichophyton rubrum and four Trichophyton indotineae. The T. rubrum strain showed minimum inhibitory concentration (MIC) (90% growth inhibition) of 4 mg/L for terbinafine. The four T. indotineae strains showed a MICs range of 0.25–4 mg/L for terbinafine. The analysis of the SQLE gene in the T. rubrum strain showed a nucleotide substitution generating a missense mutation (L393F). The SQLE gene sequencing in the T. indotineae strains showed a nucleotide substitution generating a missense mutation (F397L) in two strains, a nucleotide substitution L393S in one strain and a nucleotide substitution F415C in another strain. Conclusions: We report the first cases of terbinafine‐resistant Trichophyton isolates in the Italian population. Solid antifungal management programs will be needed to promote more responsible use of antimycotics and preserve their therapeutic efficacy to control antifungal resistance. [ABSTRACT FROM AUTHOR]

Objectives: We assessed the performance of the Seegene Novaplex™ Dermatophyte Assay for diagnosis of dermatophytosis. Methods: Sixty‐one clinical samples from skin, nail, hair and culture were selected based on RT‐PCR according to Wisselink et al. Of these samples, 26 samples were negative and 35 samples were positive with 39 dermatophytes strains. Emerging fungal strains harbouring terbinafine resistance (i.e. T. indotineae and T. mentagrophytes) were included. Results: The specificities of the Novaplex™ Dermatophyte Assay ranged between 94.3% and 97.9%. The sensitivities for the detection of T. rubrum complex, T. mentagrophytes/T. interdigitale species complex and C. albicans were 94.1% (95% CI: 71.3–99.9), 78.6% (95% CI: 49.2–95.3) and 100% (95% CI: 69.2–100), respectively, with Cohen's kappa of at least 72.9%. Conclusions: The Seegene Novaplex™ Dermatophyte Assay can be used for reliable screening of dermatophytes, including emerging strains in a routine laboratory setting. [ABSTRACT FROM AUTHOR]

Background: The skin is the first line of defence against communities of resident viruses, bacteria and fungi. The composition of the microbiome might change with factors related to the environment and host. The microbiome is dominated by bacteria. Dermatophytes and yeasts are the predominant fungi that are also involved in opportunistic infections of skin, hair and nails. Among environmental fungi, Chaetothyriales (black yeasts and relatives) are enriched by hydrocarbon pollution in domesticated habitats and comprise numerous species that cause mild‐to‐severe disease. Methods: We investigated the presence of black fungi in the skin microbiome by conducting an analysis in the publicly available metagenomic SRA database (NCBI). We focused on the causative agents of chromoblastomycosis and phaeohyphomycosis and used barcodes and padlock probe sequences as diagnostic tools. Results: A total of 132,159,577 MB was analysed and yielded 18,360 reads that matched with 24 species of black fungi. Exophiala was the most prevalent genus, and Cyphellophora europaea was the most abundant species. Conclusion: This study reveals the abundant presence of Chaetothyriales on the skin without necessarily being associated with infection. Most of the detected causal agents are known from mild skin diseases, while also species were revealed that had been reported from CARD9‐deficient patients. [ABSTRACT FROM AUTHOR]

Background: Tinea capitis and tinea corporis are highly prevalent fungal skin infections, which globally are mainly caused by Microsporum canis and Trichophyton rubrum, respectively. While in the United States and Great Britain Trichophyton tonsurans is widely prevalent as a causative pathogen, it so far only plays a minor role in Germany. Objectives: Since the frequency of pathogenic species varies regionally and temporally, this study assesses the proportion of Trichophyton tonsurans infections in the dermatology department of a large university hospital in Germany from 2019 to 2022 and thoroughly characterises the affected patient population. Patients/Methods: This retrospective study at the Technical University of Munich analyses mycological culture results regarding the identified dermatophyte and infection site. Detailed patient and disease‐related information on Trichophyton tonsurans positive patients was obtained. Results: In 2022, 23 patients of 111 dermatophyte culture‐positive patients tested positive for Trichophyton tonsurans. This accounted for 20.7% and represented a tenfold increase from 2.1% in 2019. Contact sports were only practiced by 21.7% of patients, and no common hotspot or other linkage could be identified between the cases. Additionally, 47.8% of the patients received a systemic treatment, with 30.4% visiting the clinic more than three times. In 2022, 21.7% were diagnosed with a simultaneous infection of the capillitium and body, whereas this was only observed in 7.1% of cases in 2019 to 2021. Conclusions: This study suggests an increase of Trichophyton tonsurans infections via several routes of transmission. [ABSTRACT FROM AUTHOR]

Background: Tinea capitis, atopic dermatitis and allergic rhinitis are the most common disorders endured by prepubescent children. Dermatophyte infections have been linked to allergic disorders, such as increased sensitivity to dermatophytes in patients with atopic dermatitis. Objectives: To explore the correlation between tinea capitis and allergic diseases in children and to analyse their risk factors. Methods: This study monitored epidemiological changes in childhood tinea capitis and risk factors for whom with allergic disease in a single centre in three consecutive five‐year intervals by reviewing clinical data and multivariate logistic data analysis. Results: Between 2007 and 2022, there were 127 children patients with tinea capitis, the mean age was 4.83 years, and the male‐to‐female ratio was 1.76:1. Zoophilic Microsporum canis and Trichophyton mentagrophytes were the most prevalent pathogens, and the proportions remained relatively constant every 5 years. There were 34 (26.8%) children with tinea capitis complicated with allergic disease, among them 14 children with atopic dermatitis/eczema, 13 with allergic rhinitis, 8 urticaria, 6 food allergies and 1 allergic asthma. Male, kerion, zoophilic species infections and animal contact history were prevalent features in allergic disease combined with tinea capitis. Patients with tinea capitis plus allergic disease mostly had a family history with similar complications. Conclusion: M. canis and T. mentagrophytes were the most prevalent pathogens of tinea capitis in the last 15 years; atopic dermatitis/eczema and allergic rhinitis were the most frequently associated allergic diseases. Male, kerion, zoophilic pathogen and animal contact history are risk factors. [ABSTRACT FROM AUTHOR]

Keywords: Tinea; onychomycosis; dermatophytes; disinfection EN Tinea onychomycosis dermatophytes disinfection 561 563 3 10/12/23 20231101 NES 231101 Tinea pedis and onychomycosis are common diseases. Hence, tinea pedis can progress to onychomycosis, and onychomycosis can act as a dermatophyte reservoir promoting a reinfection cycle and contributing to the high recurrence rates of these mycoses ([[4]]). [Extracted from the article]

It poses a risk of unnecessary treatment with potential adverse effects and creates diagnostic and treatment delay for other non-fungal diseases causing mucosal, skin, hair, or nail changes. Keywords: Fungal infections; dermatophytes; Faroe Islands; epidemiology EN Fungal infections dermatophytes Faroe Islands epidemiology 564 566 3 10/12/23 20231101 NES 231101 Superficial fungal infections (SFIs) are infections limited to mucosa, skin, hair, and nails ([1]). [Extracted from the article]

Dermatophytes are group of filamentous fungi which have adapted to living on the skin of humans and other animals. In the last decade, reports have emerged from Asia of new dermatophyte strains showing resistance to the commonly used antifungal agent terbinafine and others. The spread of these resistant strains has been noted in many other countries globally. Little is known about the mechanisms or management of this emerging problem. Urgent research and changes to current practice are required if the spread of the infection is to be contained and managed effectively. [ABSTRACT FROM AUTHOR]

Fungi represent an integral part of the skin microbiota. Their complex interaction network with the host shapes protective immunity during homeostasis. If host defences are breached, skin‐resident fungi including Malassezia and Candida, and environmental fungi such as dermatophytes can cause cutaneous infections. In addition, fungi are associated with diverse non‐infectious skin disorders. Despite their multiple roles in health and disease, fungi remain elusive and understudied, and the mechanisms underlying the emergence of pathological conditions linked to fungi are largely unclear. The identification of IL‐17 as an important antifungal effector mechanism represents a milestone for understanding homeostatic antifungal immunity. At the same time, host‐adverse, disease‐promoting roles of IL‐17 have been delineated, as in psoriasis. Fungal dysbiosis represents another feature of many pathological skin conditions with an unknown causal link of intra‐ and interkingdom interactions to disease pathogenesis. The emergence of new fungal pathogens such as Candida auris highlights the need for more research into fungal immunology to understand how antifungal responses shape health and diseases. Recent technological advances for genetically manipulating fungi to target immunomodulatory fungal determinants, multi‐omics approaches for studying immune cells in the human skin, and novel experimental models open up a promising future for skin fungal immunity. [ABSTRACT FROM AUTHOR]

Background: Tinea pedis is the most common form of dermatophytosis resulting in interdigital infections. All of Us (AoU) is a National Institute of Health initiative with an emphasis on patient populations traditionally underrepresented in biomedical research. Objectives: Our objective was to evaluate the burden of tinea pedis in underrepresented groups in the United States, utilising the novel AoU research program. Methods: We analysed AoU Registered Tier dataset version 5, which includes data collected between 30 May, 2017, and 1 April, 2021. We conducted a cross‐sectional analysis linking survey and electronic health record (EHR) data to estimate the prevalence of tinea pedis in underrepresented groups. Results: All of Us data release includes 329,038 participants. Of these, 251,597 (76.5%) had electronic health record data and 6932 had tinea pedis (overall prevalence, 2.76%; 95% CI, 2.69–2.82). Multivariate analyses revealed that compared with White participants, Black and Hispanic participants had a higher adjusted odds of tinea pedis (OR, 1.29; 95% CI, 1.20–1.38 and OR, 1.38; 95% CI, 1.28–1.48, respectively). Higher adjusted odds of tinea pedis were observed in underrepresented groups defined by: age > =75 years (OR, 1.45; 95% CI, 1.33–1.57), LGBTQ status (OR, 1.17; 95% CI, 1.09–1.27), less than a high school education (OR, 1.22; 95% CI, 1.11–1.34), income <$35,000 (OR, 1.09; 95% CI, 1.02–1.16) and physical disability (OR, 1.56; 95% CI, 1.08–1.24). Conclusions: Our findings are consistent with overall age, and gender‐specific prevalence estimates from prior epidemiologic studies, validating the scientific consistency of the new AoU database. Additionally, there may be an increased burden of tinea pedis among Black and Hispanic individuals. [ABSTRACT FROM AUTHOR]

Background: Onychomycosis (OM) accounts for about 50% of nail disorders in industrialised countries. Essential oils (EOs), aromatic natural compounds, are known for their antimicrobial activity. Objective: The aim of this work was to evaluate the antifungal efficacy of seven EOs and a commercial MIX against 10 dermatophytes responsible for OM to select the most effective ones to be included in a preventive or curative formulation based on a green natural nail polish (GNNP). Methods: Micro‐broth dilution tests in line with EUCAST guidelines and olfactory satisfaction test were performed to select the best natural compounds previously analysed by SPME coupled with GC‐MS. The same method was used to evaluate the release over time of the active compounds present in the two modified‐GNNPs made by adding the best natural compound selected (the C. citratus EO) and the MIX. Furthermore, to evaluate the preventive and curative activity of modified‐GNNPs, ex vivo experiments on healthy or colonised nails were performed. Results and Conclusions: Data showed that MIX‐modified‐GNNP had preventive activity as it inhibits the fungal growth by releasing its active ingredients for 7 days, while the OE‐modified GNNP acts as a natural drug showing cytocidal activity on nails colonised by dermatophytes, but it requires two weekly applications. [ABSTRACT FROM AUTHOR]

Indeed, sporadic human and animal infections were described before the diffusion of yellow phenotype strains in Europe.3 Notably, the white phenotype is very similar to I T. mentagrophytes i . All fungal isolates grew easily in culture, confirming what is known for these species.3 A detailed mycological description of the I T. benhamiae i clade can be found elsewhere.3,9 To summarise, the more widely distributed zoophilic species ( I T. benhamiae i var. I benhamiae i , I T. europaeum i and I T. japonicum i ) have a " I T. mentagrophytes i -like" appearance (Figure 4). Trichophyton benhamiae var. luteum and T. europaeum - recently described dermatophytes within the T. benhamiae complex - were identified in nine cases of dermatophytosis involving guinea pigs, chinchillas and dogs. Cases of dermatophytosis caused by Trichophyton benhamiae var. luteum and T. europaeum, newly described dermatophytes within the T. benhamiae complex. [Extracted from the article]

Dermatophytes are pathogenic fungi, comprising the major cause of superficial fungal infections called dermatophytes. Although they infect keratinized tissues such as skin, nail, and hair, invasive serious infections may occur in immunocompromised patients. However, current antifungal drugs show considerable drawbacks, such as toxicity and multiple drug resistance, compelling and directing researches for new antidermatophyte agents. Herein, a series of hydroxypyrone bearing compounds inspired from the natural metabolite kojic acid was reported. Their antidermatophytic effects of the compounds against Microsporum gypseum, Trichophyton mentagrophytes var. erinaceid, and Epidermophyton floccosum were evaluated. The cytotoxicity of the compounds on healthy (MRC‐5) and carcinogenic (He‐La) cell lines was also investigated, and their cytopathogenic effects were expressed as maximum non‐toxic concentrations. According to the activity studies, compounds 10 and 22 were found as the most promising antidermatophytic agents (MIC: 2 μg/ml), exhibiting comparable effect with that of griseofulvin (MIC: 0.5–1 μg/ml) and terbinafine (MIC: 0.125–0.5 μg/ml) which are the most widely used agents for treating mycoses caused by dermatophytes. Molecular docking analysis of the most active compounds, compound 10 and compound 22, with homology model of β‐tubulin protein was carried out to investigate the possible binding conformation of the compounds in the targeted macromolecule. [ABSTRACT FROM AUTHOR]

Background: During the COVID‐19 pandemic, wearing PPE can induce skin damage such as erythema, pruritus, erosion, and ulceration among others. Although the skin microbiome is considered important for skin health, the change of the skin microbiome after wearing PPE remains unknown. Objective: The present study aimed to characterize the diversity and structure of bacterial and fungal flora on skin surfaces of healthcare workers wearing personal protective equipment (PPE) during the COVID‐19 pandemic using metagenomic next‐generation sequencing (mNGS). Methods: A total of 10 Chinese volunteers were recruited and the microbiome of their face, hand, and back were analysed before and after wearing PPE. Moreover, VISIA was used to analyse skin features. Results: Results of alpha bacterial diversity showed that there was statistically significant decrease in alpha diversity indice in the skin samples from face, hand, and three sites after wearing PPE as compared with the indice in the skin samples before wearing PPE. Further, the results of evaluated alpha fungal diversity show that there was a statistically significant decrease in alpha diversity indices in the skin samples from hand after wearing PPE as compared with the indices in the skin samples before wearing PPE (P < 0.05). Results of the current study found that the main bacteria on the face, hand, and back skin samples before wearing the PPE were Propionibacterium spp. (34.04%), Corynebacterium spp. (13.12%), and Staphylococcus spp. (38.07%). The main bacteria found on the skin samples after wearing the PPE were Staphylococcus spp. (31.23%), Xanthomonas spp. (26.21%), and Cutibacterium spp. (42.59%). The fungal community composition was similar in three skin sites before and after wearing PPE. Conclusion: It was evident that wearing PPE may affect the skin microbiota, especially bacteria. Therefore, it was evident that the symbiotic microbiota may reflect the skin health of medical workers during the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Treatment of tinea pedis and onychomycosis is complicated by high rates of reinfection and the emergence of terbinafine‐resistant strains of Trichophyton spp. Effective disinfection of contaminated socks is an important measure. Appropriate washing reduces the risk of reinfection and is paramount in treating tinea pedis and onychomycosis. Objectives: The aim of this study was to describe the effect of commonplace disinfection methods using socks pieces inoculated with terbinafine‐resistant or terbinafine‐susceptible isolates of Trichophyton spp. Methods: Sock pieces were inoculated with seven terbinafine‐resistant isolates of Trichophyton spp. with known mutations in the SQLE‐gene (T. rubrum (n = 3), T. interdigitale (n = 1) and T. indotineae (n = 3)) and six terbinafine‐susceptible isolates of Trichophyton spp. (T. rubrum (n = 3) and T. interdigitale (n = 3)). Methods of disinfection included soaking in a quaternary ammonium (QAC) detergent (0.5, 2 and 24 h), freezing at −20°C (0.5, 12 and 24 h), domestic and steam washing (both at 40°C with detergent). Sock pieces were cultured for 4 weeks following disinfection. The primary end point was no growth at the end of week 4. Results: Soaking in a QAC‐detergent for 24 h procured at disinfectant rate of 100% (13/13), whilst soaking in 0.5 and 2 h had a disinfectant rate of 46.2% (6/13) and 84.6% (11/13), respectively. Domestic washing (40°C with detergent) produced a disinfectant rate of 7.7% (1/13). Freezing at −20°C (0.5, 12 and 24 h) and steam washing (40°C with detergent) had no disinfectant properties. Conclusions: Soaking in a QAC‐detergent for 24 h effectively disinfected sock pieces contaminated with dermatophytes. [ABSTRACT FROM AUTHOR]

Background: Dermatophytoses are the most common infectious skin disease. Its epidemiology varies in different countries and regions, and its prevalence in China is still unknown. Objectives: We aimed to reveal the epidemiological features of dermatophytoses in Chinese mainland in the past thirty years. Methods: From 1991 to 2020, a 30‐year retrospective epidemiological study was carried out. All published literatures containing dermatophytoses and dermatophytes were collected and analysed. Results: A total of more than 180,000 cases in 124 articles from more than 100 hospitals were included and analysed. Among dermatophytoses, tinea cruris (24.92%) was the predominant clinical type, followed by tinea pedis (22.97%) and tinea corporis (18.12%). In recent 10 years, tinea pedis (25.40%) was more common than tinea cruris (22.39%) and became the most common infection. Among dermatophytes, T rubrum (69.48%) has always been the most common isolates, followed by T mentagrophytes (16.45%) and M canis (8.09%). Other species were found below 3%. In superficial mycoses, dermatophytes accounted for 75.52%, higher than that of yeasts/yeast‐like (21.83%) and moulds (2.65%). The prevalence of tinea capitis was lower in economically developed eastern region than that in central and western regions. Tinea cruris was more common in warm zones than cold zones. Conclusions: The top three dermatophytoses are tinea cruris, tinea pedis and tinea corporis, while the top three dermatophytes are T rubrum, T mentagrophytes and M canis. The distribution of dermatophytoses may be influenced by socioeconomic status and geographical‐meteorological conditions. [ABSTRACT FROM AUTHOR]

Aims: The present study aimed to investigate the antifungal activity of amphotericin B‐loaded nanoliposomes against Trichophyton interdigitale and Trichophyton rubrum. Moreover, it was attempted to assess the obtained resistance in vitro. Methods: In total, 29 archived clinical strains, namely, T. interdigitale (n = 16) and T. rubrum (n = 13), were included in this study. These strains were determined using a previous ITS1‐ITS2 region sequence. Moreover, a liposomal formulation of amphotericin B was formulated by a thin‐film hydration method. Particle size, polydispersity index (PdI), and zeta potential (ZP) were measured by a Zetasizer. Furthermore, physicochemical properties, such as appearance, aggregation of particles, particle size, PdI, and ZP, were determined at 0‐, 1‐, and 3‐month intervals. A scanning electron microscope (SEM) was also used to examine nanoparticles structure. The minimum inhibitory concentration (MIC) of amphotericin B‐loaded nanoliposomes, itraconazole, efinaconazole, terbinafine, and ciclopirox was determined according to the protocol of the broth microdilution method of CLSI M38‐A2. The morphological changes of T. interdigitale and T. rubrum strains exposed to the amphotericin B‐loaded nanoliposomes were observed using SEM. Results: The amphotericin B‐loaded nanoliposomes displayed a lower MIC compared to those of the amphotericin B and liposomes when used separately. Based on the results, amphotericin B‐loaded nanoliposomes induced no drug resistance in any of the tested strains. Conclusion: Accordingly, amphotericin B‐loaded nanoliposomes can be a potent antifungal for the topical treatment of onychomycosis. There was no in vitro evidence regarding the resistance of the tested strains to amphotericin B‐loaded nanoliposomes. This reflects that amphotericin B‐loaded nanoliposomes have a low probability to induce drug resistance in dermatophyte species. [ABSTRACT FROM AUTHOR]

Background: Traditionally, KOH microscopy and fungal culture are the two preferred tests as gold standard for diagnosis of onychomycosis. Recently, other diagnostic methods have been developed to improve the microbiological diagnosis. The EUROArray dermatomycosis kit is a PCR‐based microarray test system for the detection and direct identification of species that are most frequently involved in skin and nail infections. Objectives: Our primary aim was to evaluate the real‐life applicability of the EUROArray dermatomycosis kit in the diagnosis of onychomycoses. In addition, we compared the aetiology of onychomycoses found in our patients with those described in the literature. Patients/Methods: We prospectively studied consecutive 100 patients with suspected onychomycoses. Samples of suspect toenails were taken as part of routine medical management. Nail specimens were evaluated by means of three diagnostic methods: KOH preparation, culture and EUROArray dermatomycosis kit. Results: Onychomycosis was diagnosed in 47/100 patients who proved positive on at least one reference diagnostic test and in 49/100 patients who proved positive on PCR. The combination of microscopy and PCR had better sensitivity than microscopy (p =.0397), fungal culture (p =.0061) and PCR alone (p =.0117). Moulds were more frequently positive in culture than in PCR (p =.033). Dermatophytes proved positive more frequent than moulds and yeasts in both culture and PCR; in particular, Trichophyton interdigitale was the most frequent pathogen. Conclusions: In conclusion, introducing EUROArray dermatomycosis kit into the diagnostic algorithm of onychomycosis increases the sensitivity of direct microscopy and yields more rapid results than culture. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin disease with an increasing prevalence worldwide. The aetiology and pathogenesis of AD have not been fully elucidated. Previous studies have suggested the role of fungi as a triggering factor in the development AD. Here we conducted a systematic review to investigate the skin mycobiome profiles in AD and to address whether there is an association between fungal dysbiosis and AD. We searched Medline/PubMed, Embase and Web of Science for research studies published in English between January 1st, 2010 and April 21st, 2021. A total of 11 human studies and 3 animal studies were included in this analysis. Fungal dysbiosis was observed in AD lesions with a depleted amount of Malassezia and a higher abundance of filamentous fungi. A positive correlation between Candida and Staphylococcus was also demonstrated in AD. We supposed that specific species of Malassezia spp. and Candida spp. may play a role in the pathogenesis of AD by interacting with the pathogenic bacteria. Topical application of emollients could improve the skin barrier function and restore the skin fungal flora by increasing the amount of Malassezia. Further studies focusing on the complex interplay between specific skin fungi and the host can provide better insight into the role of microorganisms in the pathogenesis of AD. [ABSTRACT FROM AUTHOR]

Background: Tinea capitis is a common dermatophyte infection of the scalp primarily affecting children, with less frequent, though not rare, observation in adults. Objective: This study aimed to assess changes in the causative agents of adult tinea capitis over a 60‐year period in the Hubei area. Methods: A retrospective, single‐centre study was performed on 164 adults with tinea capitis between 1960 and 2020. Results: Out of 1113 cases of tinea capitis, 164 patients were adults, representing 14.7% of all patients. Adult tinea capitis was slightly more prevalent in males (91, 55.5%) than in females (73, 44.5%), but gender difference was not statistically significant between adults and children. Adult tinea capitis was most prevalent between the ages of 18 and 29 years, with a mean age of 22 years. Trichophyton schoenleinii was the most common dermatophyte in adult tinea capitis (78, 47.6%), followed by Trichophyton violaceum (58, 35.4%). Most adult tinea capitis cases before the 1980s were caused by T. schoenleinii, but T. violaceum has become the leading pathogen for recent adult tinea capitis cases. Conclusion: Tinea capitis is not a disease exclusive to children. On the contrary, an upward trend of tinea capitis in adults has been observed in recent years. T. violaceum has become the dominant causative agent of adult tinea capitis in the Hubei area, replacing T. schoenleinii. These results provide a better understanding of the treatment and prevention of tinea capitis in adults. [ABSTRACT FROM AUTHOR]

Background: Species from the Trichophytonbenhamiae complex are mostly zoophilic dermatophytes which cause inflammatory dermatophytosis in animals and humans worldwide. Objectives: This study was purposed to (a) to identify 169 reference and clinical dermatophyte strains from the T benhamiae complex species by molecular method and adhering to the newest taxonomy in the complex (b) to evaluate the in vitro antifungal susceptibility profile of these strains against eight common and new antifungal agents that may be used for the treatment of dermatophytosis. Methods: All isolates, mainly originated from Europe but also from Iran, Japan and USA, were subjected to ITS‐rDNA sequencing. The in vitro antifungal susceptibility profiles of eight common and new antifungal drugs against the isolates were determined by CLSI M38‐A2 protocol and according to microdilution method. Results: Based on the ITS‐rDNA sequencing, T benhamiae was the dominant species (n = 102), followed by T europaeum (n = 29), T erinacei (n = 23), T japonicum (n = 10), Trichophyton sp (n = 4) and T eriotrephon (n = 1). MIC ranges across all isolates were as follows: luliconazole: 0.0002–0.002 µg/ml, terbinafine: 0.008–0.125 µg/ml, efinaconazole: 0.008–0.125 µg/ml, ciclopirox olamine: 0.03–0.5 µg/ml, itraconazole: 0.06–2 µg/ml, griseofulvin: 0.25–4 µg/ml, amorolfine hydrochloride: 0.125–4 µg/ml and tavaborole: 1–16 µg/ml. Conclusion: Luliconazole, efinaconazole and terbinafine were the most potent antifungals against T benhamiae complex isolates, regardless of the geographic locations where strains were isolated. These data might help dermatologists to develop effective therapies for successful treatment of infections due to T benhamiae complex species. [ABSTRACT FROM AUTHOR]

Background: Epidemiological studies indicate that onychomycosis may affect up to 79% of psoriatic patients. Onychomycosis in psoriatic patients is more commonly caused by yeasts comparing with non‐psoriatic. Objectives: Evaluate the prevalence of fungi in nail psoriasis. Evaluate the association between direct mycological examination (DME) and mycological culture, Nail Psoriasis Severity Index (NAPSI) and systemic treatment for psoriasis. Methods: Of 133 nails from 20 patients with nail psoriasis were evaluated as follows: 9 patients were using topical treatment and 11 were on systemic treatment. The assessment of psoriasis severity using NAPSI was performed in all psoriatic nails. The presence of fungi was confirmed in DME and culture. Results: DME showed the presence of fungal elements in 45 nails (33.83%) with a predominance of blastoconidia (95.5%) No septate hyphae were seen. Mycological culture was positive in 36 (27.06%) samples. Among them, Candida grew in 31 (86.1%): Candida parapsilosis in 15 (48.38%), Candida spp in 14 (45.16%). No growth of dermatophytes was observed. Patients with systemic treatment showed a higher frequency of positive test (DME and culture) for fungi when compared to topic treatment (p:.006). There was a positive correlation between NAPSI, mycological culture and systemic treatment (p:.0063); the risk was four times higher (OR:4.0). Limitation of the study: Sample size. Conclusion: These results are consistent with some previous reports, Candida was the fungus with higher frequency on the psoriatic nails, however, the role of these fungi is controversial (contamination x colonisation x infection). The fact that the immunosuppressive treatment increases the chance of fungal infection leads us to a greater attention to this patient profile, to prevent the intensification of nail psoriasis (Köbner phenomenon). [ABSTRACT FROM AUTHOR]

Objectives: Onychomycosis is the general term to define fungal nail infections that arise from dermatophytes, non‐dermatophytic moulds and yeasts. Thiol/disulphide homeostasis is a new indicator of oxidative stress. In this study, we aimed to investigate the role of thiol/disulphide balance in the pathogenesis of onychomycosis. Methods: This cross‐sectional study included adult patients with onychomycosis who were admitted to the dermatology department and healthy adult volunteers without any dermatologic or systemic condition. The patients and controls were evaluated in terms of native thiol, total thiol, and disulphide levels, and disulphide/native thiol, disulphide/total thiol and native thiol/total thiol ratios. The possible association between these parameters and clinical subtypes of onychomycosis and demographic characteristics was also investigated. Results: A total of 52 patients with onychomycosis and 50 healthy subjects were enrolled in the study. The patient group showed lower levels of total thiol, native thiol and native thiol/total thiol ratio, and higher ratios of disulphide/native thiol and disulphide/total thiol. No statistically significant relationship was found between the parameters, clinical subtypes of onychomycosis and demographic characteristics (p >.05). Conclusion: Patients with onychomycosis showed a shifted thiol/disulphide homeostasis towards oxidative stress with a reduction in thiols and an increase in disulphide/native thiol, and disulphide/total thiol ratios. These findings may indicate the role of oxidative stress in the pathogenesis of onychomycosis. [ABSTRACT FROM AUTHOR]

Background: Accurate and early identification of dermatophytes enables prompt antifungal therapy. However, phenotypic and molecular identification methods are time‐consuming. MALDI‐TOF MS‐based identification is rapid, but an optimum protocol is not available. Objectives: To develop and validate an optimum protein extraction protocol for the efficient and accurate identification of dermatophytes by MALDI‐TOF MS. Materials/methods: Trichophyton mentagrophytes complex (n = 4), T. rubrum (n = 4) and Microsporum gypseum (n = 4) were used for the optimisation of protein extraction protocols. Thirteen different methods were evaluated. A total of 125 DNA sequence confirmed clinical isolates of dermatophytes were used to create and expand the existing database. The accuracy of the created database was checked by visual inspection of MALDI spectra, MSP dendrogram and composite correlation index matrix analysis. The protocol was validated further using 234 isolates. Result: Among 13 protein extraction methods, six correctly identified dermatophytes but with a low log score (≤1.0). The modified extraction protocol developed provided an elevated log score of 1.6. Significant log score difference was observed between the modified protocol and other existing protocols (T. mentagrophytes complex: 1.6 vs. 0.2–1.0, p <.001; T. rubrum: 1.6 vs. 0.4–1.0, p <.001; M. gypseum:1.6 vs. 0.2–1.0, p <.001). Expansion of the database enabled the identification of all 234 isolates (73.5% with log score ≥2.0 and 26.4% with log scores range: 1.75–1.99). The results were comparable to DNA sequence‐based identification. Conclusion: MALDI‐TOF MS with an updated database and efficient protein extraction protocol developed in this study can identify dermatophytes accurately and also reduce the time for identifying them. [ABSTRACT FROM AUTHOR]

Background: Dermatophytes showing reduced sensitivity to antifungal agents have emerged in several countries. One terbinafine resistant strain of Trichophyton rubrum, TIMM20092, also showed reduced sensitivity to itraconazole (ITC) and voriconazole (VRC). The expression of two genes (TruMDR2 and TruMDR3) encoding multidrug transporters of the ABC family was found to be highly up‐regulated in this strain. Deletion of TruMDR3 in TIMM20092 abolished its resistance to VRC but only slightly reduced its resistance to ITC. Objectives: We examined the potential of T rubrum to develop resistance to ITC by analysing the mechanism of ITC resistance in TIMM20092. Methods: The deletion of TruMDR2 by gene replacement was performed in TIMM20092 and one TruMDR3‐lacking mutant (∆TruMDR3) previously generated from TIMM20092. TruMDR2 single and TruMDR2/TruMDR3 double mutants (∆TruMDR2 and ∆TruMDR2/3) were successfully obtained, respectively. Results: The suppression of TruMDR2 was shown to abolish resistance to ITC in TIMM20092 and the TruMDR3‐lacking mutant, strongly suggesting that TruMDR2 is a major contributor to ITC resistance in TIMM20092. Conclusions: Our study highlights the possible role of the ABC transporter TruMDR2 in ITC resistance of T. rubrum. [ABSTRACT FROM AUTHOR]

Superficial mycoses of skin, nails and hair are among the common fungal infections. They are caused by dermatophytes, non‐dermatophyte moulds, yeasts and yeast‐like fungi. Such fungal infections are widespread all over the world and are predominant in tropical as well as subtropical regions. Environmental factors, such as warm, humid and pitiable hygienic conditions, are conducive for their growth and proliferation. Although it does not cause mortality, it is known to be associated with excessive morbidity which may be psychological or physical. This affects the quality of life of the infected individuals which leads to a negative impact on their occupational, emotional and social status. Such infections are increasing on a global scale and, therefore, are of serious concern worldwide. This review article covers the global and Indian scenario of superficial mycoses taking into account the historical background, aetiological agents, prevalence, cultural and environmental factors, risk factors, pathogenesis and hygienic practices for the prevention of superficial mycoses. [ABSTRACT FROM AUTHOR]

Background: Tinea pedis is often chronic or recurrent, but not all individuals are equally susceptible to this infection. Dermatophytes are able to induce the expression of antimicrobial peptides and proteins (AMPs) in human keratinocytes and certain AMPs can inhibit the growth of dermatophytes. Objective: The focus of this study was to analyse the secretion of relevant AMPs, especially RNase 7, human beta‐defensin‐2 (hBD‐2) and the S‐100 protein psoriasin (S100A7), in patients with confirmed tinea pedis. Methods: To verify the diagnosis, skin scales were obtained from all patients (n = 13) and the dermatophytes were identified by potassium hydroxide mount, culture and molecular analysis. To determine the AMP concentrations, the lesional skin area of the foot was rinsed with a buffer that was subsequently analysed by ELISA. The corresponding area of the other unaffected foot as well as defined healthy skin areas of the forearm and forehead and samples from age and gender‐matched healthy volunteers served as controls. Results: In tinea pedis patients the AMP concentrations were higher in lesional skin than in non‐lesional skin and in healthy skin of controls. In particular, concentrations of hBD‐2 and psoriasin were significantly elevated. Conclusions: The induction of AMPs in tinea pedis might be triggered directly by the dermatophytes; furthermore, attendant inflammation and/or differentiation processes may play a role. Our results indicate that there is no defect in the constitutive expression and induction of the analysed AMPs by dermatophytes in the epidermis of affected patients. However, it is not known why the elevated AMP concentrations fail to efficiently combat dermatophyte growth. [ABSTRACT FROM AUTHOR]

Background: Dermatophytes are the most common fungal pathogens causing superficial infections in humans with a high prevalence worldwide. The treatment of these infections is based on the use of topical and systemic antifungal agents. A convenient method with a high predictive value for testing the susceptibilities of dermatophytes is necessary. Objective: To evaluate the ability of the Sensititre YeastOne® in testing the activity of nine antifungal agents against dermatophytes. Methods: We compared Sensititre® with reference procedure for anidulafungin (ANID), micafungin sodium (MCF), caspofungin acetate (CAS), 5‐fluorocytosine (5FC), posaconazole (PCZ), voriconazole (VCZ), itraconazole (ITZ), fluconazole (FLZ) and amphotericin B (AMB) against 79 dermatophyte isolates, the essential agreement (EA) and categorical agreement (CA) between the two methods were obtained. Results: The MICs or MECs obtained by the Sensititre® were usually lower than those obtained by the M38‐A2. The overall EA between the two methods of nine antifungals was best for 5FC (100%), followed by MCF (94.9%), PCZ (84.8%), AMB (67.1%), FLZ (65.8%), VCZ (63.3%), ANID (29.1%), ITZ (20.3%) and CAS (2.5%). The overall CA between the two methods for all drugs was 100% except for ANID (97.4%), MCF (95%) and PCZ (92.5%). Substantial discrepancies were observed with all drugs except for VCZ and 5FC. The results of M38‐A2 in terms of GMIC (or GMEC) and MIC90 (or MEC90) were, in increasing order, as follows: MCF, PCZ, VCZ, ANID, ITZ, CAS, AMB, FLZ and 5FC. Conclusions: The Sensititre YeastOne® shows poor EA with the reference method for dermatophytes; therefore, M38‐A2 should remain the reference procedure for antifungal susceptibility testing against dermatophytes. [ABSTRACT FROM AUTHOR]

Dermatophytosis is a superficial fungal infection that affects humans and is very common in small animals. The treatment using the most commonly used antifungals is failing, and new therapeutic alternatives are required to combat the resistance of these fungal infections. Previous studies by the group have shown that clioquinol is an important therapeutic alternative in the treatment of dermatophytosis. The object was to conduct studies of antidermatophytic activity and the irritant potential from the double and triple combinations of clioquinol, terbinafine and ciclopirox in ex vivo and in vivo alternative models. To evaluate the irritant potential of antifungal combinations, the alternative HET‐CAM method (chicken egg test chorioallantoic membrane) was used. Ex vivo models were used to assess the effectiveness of antifungal combinations, using pig hooves and veterinary fur. Any possible tissue damage was to assess through in histopathology of swine ears. HET‐CAM results showed that all combinations can be classified as non‐irritating, corroborated by the results of the histopathological evaluation of the pig's ear skin. Only the double combinations managed to remove 100% of the colony‐forming units (CFU) formed on the pig's hooves. The clioquinol + terbinafine combination and the triple combination were more effective than clioquinol + ciclopirox in eradicating the preformed biofilm in fur of veterinary origin. These results show the potential of formulations of clioquinol in combination with antifungals for use in humans and in the veterinary field to combat dermatophytosis, as an important alternative therapy, for use in the near future. [ABSTRACT FROM AUTHOR]

Background: Dermatophytosis is a world‐wide distributed common infection. Antifungal drug resistance in dermatophytosis used to be rare, but unfortunately the current Indian epidemic of atypical widespread recalcitrant and terbinafine‐resistant dermatophytosis is spreading and has sporadically been reported in Europe. Objectives: To explore the occurrence of clinical and mycological proven antifungal drug resistance in dermatophytes in Europe. Methods: A standardized questionnaire was distributed through the EADV Task Force of Mycology network to dermatologists in Europe. Results: Representatives from 20 countries completed the questionnaires of which 17 (85 %) had observed clinical and/or mycological confirmed antifungal resistance, two countries published cases of antifungal resistance and one country had no known cases. Conclusions: This pilot study confirms that both clinical and mycological antifungal resistance exist in Europe. [ABSTRACT FROM AUTHOR]

The South‐Asian epidemic of anti‐fungal therapeutic failures (AFTF) is on the rise. Although many demographic, environmental, and socioeconomic factors have been implicated in the genesis of this problem, two pharmacological issues warrant attention. While detailed discussions on the role of topical corticosteroid (TCS) in the changing landscape of the superficial mycotic infections in this region have been making headlines, another equally, rather more important pharmacological factor seems to have been undermined by the hype around TCS. The fastidious pharmacokinetic properties and related practical aspects of the triazole group of oral and topical antifungals, especially oral itraconazole seem to contribute significantly to the persistence of AFTF epidemic. In this paper, we shall discuss the broad aspects of the spectral precariousness of oral triazole antifungals with special emphasis to itraconazole, a concept known as the "azole menace" in the overall pathogenesis and tenacity of the AFTF epidemic. [ABSTRACT FROM AUTHOR]

Background: Trichophyton schoenleinii is an anthropophilic dermatophyte that causes tinea favosa. Nowadays, it remains an important pathogen in some regions of the world, mainly epidemic in Africa and West Asia. Despite the medical importance of T. schoenleinii infections, a high‐quality reference genome for T. schoenleinii is still unavailable, neither its transcriptomic profile. Objectives: The aim of the current study was to improve understanding of the underlying pathogenic mechanism of T. schoenleinii, and to define the candidate pathogenic genes of T. schoenleinii. Methods: Comprehensive genomic analysis of T. schoenleinii was carried out by Illumina and PacBio sequencing platforms. Transcriptome profiles of T. schoenleinii cultured in vitro in two media containing either keratin or soy protein were determined using RNA sequencing (RNA‐seq) technology. Results: Here, we present the first draft genome sequence of T. schoenleinii strain T2s, which consists of 11 scaffolds containing 7474 predicted genes. Transcriptome analysis showed that genes involved in keratin hydrolysis have higher expression in T. schoenleinii grown in keratin medium, including genes encoding proteases, cysteine dioxygenase and acetamidase. Other genes with higher expression include genes encoding the components of the pH‐responsive signal transduction pathways and transcription factors, many of which may play a role in pathogenicity. Conclusion: In summary, this study provides new insights into the pathogenic mechanism of T. schoenleinii and highlights candidate genes for further development of novel targets in disease diagnosis and treatment of tinea favosa. [ABSTRACT FROM AUTHOR]

Background: Black opportunists Phialophora verrucosa complex species can cause different disease types in competent and in immunocompromised individuals, but are remarkably overrepresented in CARD9‐related infections. Objectives: To better understand the ecology and potential pathogenicity of opportunistic Phialophora species and reveal eventual genetic parameters associated with the behaviour in vivo and genetic profiles in patients with CARD9 immunodeficiency. Methods: Genomes of 26 strains belonging to six species of the Phialophora verrucosa complex were sequenced. Using multilocus analysis, all environmental and clinical strains were identified correctly. We compared the genomes of agents from different disease types among each other including CARD9 immunodeficiency. Results: We obtained genome sizes of the 26 Phialophora strains ranged between 32 and 37 MB. Some species showed considerable intraspecific genomic variation. P americana showed the highest degree of variability. P verrucosa was variable in CAZy enzymes, whereas P americana varied in PKS‐related genes. Phialophora species, particularly P verrucosa, are relatively frequent in patients with CARD9‐related immunodeficiency. Different mutations in the CARD9 gene seem to increase susceptibility for infection by different groups of species, that is either Candida, dermatophytes or black fungi. A number of patients with chromoblastomycosis revealed an as yet unknown CARD9 mutation. TNFα impairment was prevalent in patients with CARD9 infections, while CBM patients were invariably IFNγ. Conclusions: From genomic investigations, the known virulence factors between clinical and environmental strains did not reveal any significant difference. Phialophora complex has an equal chance to cause infection in humans, either healthy or CARD9‐impaired. [ABSTRACT FROM AUTHOR]

Tinea capitis remains a common public health problem worldwide, especially in developing countries. Objectives: To investigate the changes of the predominant dermatophytes of tinea capitis in children in Hangzhou in recent 9 years. Methods: The age, gender and pathogen spectrum of 650 children with tinea capitis at the Department of Dermatology, Affiliated Third People's Hospital of Hangzhou, Anhui Medical University from 2011 to 2019 were analysed, and the distribution of pathogens from 1998 to 2000 was compared. Results: Among the 650 cases, 340 cases (48.2%) were males and 310 cases (51.8%) were females. The main population infected with tinea capitis was children aged 0–10 years (620 cases, 95.4%). From 2011 to 2019, the predominant dermatophyte was changed from Trichophyton violaceum (2011) to Trichophyton mentagrophytes complex (2012‐2015) and later to Microsporum canis (2016‐2019). In the past 9 years, M. canis (250 cases, 38.5%) was the most common dermatophyte and followed by T mentagrophytes complex (209 cases, 32.2%). The dermatophyte spectrum was statistically different between the years 2011 and 2019 (Chi square: χ2 = 69.75, P <.05), and the differences in anthropophilic and zoophilic pathogens between 1989‐2000 and 2011‐2019 were statistically significant (χ2 = 24.4, P <.05). Conclusions: Research showed that children diagnosed with tinea capitis were mainly 0‐10 years old. With age, the percentage of anthropophilic dermatophytes gradually increased, while the percentage of zoophilic dermatophytes decreased. M. canis was the predominant dermatophyte of tinea capitis in children, followed by T. mentagrophytes complex. The dermatophytes have shifted from anthropophilic to zoophilic dermatophytes in the past two decades. [ABSTRACT FROM AUTHOR]

Dermatophytosis is a skin infection caused by keratinophilic, filamentous fungi. These are highly prevalent, common mycoses, affecting approximately 20% of the population. These fungi invade the stratum corneum, and other keratinised tissues, like nails and hair, where they grow by secreting enzymes and degrading keratin to obtain nutrients. Clinical presentation is variable and may depend on many factors, such as the infection site, the host's immunity and the dermatophyte's virulence. Generally, patients with acute superficial dermatophytosis mount cell‐mediated immune responses. However, those suffering from chronic or recurrent infections are unable to develop this response, for reasons yet unknown. Several reports have described severe and occasionally life‐threatening invasive diseases (deep dermatophytosis) associated with genetic mutations in the innate immunity‐associated molecule CARD9, displaying the need to better understand its immune response. These dermatoses have substantial clinical consequences, producing chronic and difficult to treat skin lesions. They also lead to a decline in the patient's quality of life and impact their self‐esteem. This review summarises findings on the immune response against dermatophytes. [ABSTRACT FROM AUTHOR]

Background: Dermatophytoses have gained interest worldwide due to the increased resistance to terbinafine and azoles and difficulty in management of these refractory diseases. Objectives: In this study, we identified and analysed Trichophyton mentagrophytes clinical isolates obtained from humans with infections of animal origin. Methods: We used quantitative real‐time PCR (qRT‐PCR) to examine the transcriptional modulation of three MDR genes (PDR1, MDR2 and MDR4) and analysed squalene epoxidase (SQLE) gene sequences from multidrug‐resistant Trichophyton mentagrophytes isolates. Results: The expression profile revealed a 2‐ to 12‐fold increase in mRNA accumulation in the presence of any of the antifungals, compared to cells incubated without drugs. A statistically significant relationship between the isolates exposed to itraconazole and increased expression of the tested genes was revealed. Substantially lower transcription levels were noted for cells exposed to luliconazole, that is, a third‐generation azole. Additionally, in the case of 50% of terbinafine‐resistant strains, Leu397Phe substitution in the SQLE gene was detected. Furthermore, the reduced susceptibility to itraconazole and voriconazole was overcome by milbemycin oxime. Conclusions: In conclusion, our study shed more light on the role of the ABC transporter family in T. mentagrophytes, which, if overexpressed, can confer resistance to single azole drugs and even cross‐resistance. Finally, milbemycin oxime could be an interesting compound supporting treatment with azole drugs in the case of refractory dermatomycoses. [ABSTRACT FROM AUTHOR]