Onychomycosis, a fungal nail infection, is primarily caused by dermatophytes, yeasts, and non-dermatophyte moulds (NDMs). The incidence of this disease and the predominance of specific pathogens vary across different regions and evolve. This study aimed to elucidate the epidemiology of onychomycosis and the pattern of causative pathogens in Beijing, and to ascertain the in vitro antifungal susceptibility profiles of Trichophyton rubrum against itraconazole (ITR), terbinafine (TER), and fluconazole (FLU). Involving 245 patients of onychomycosis with positive fungal culture results, the study implemented internal transcribed spacer (ITS) sequencing of ribosomal DNA (rDNA) on all collected samples. The mean age of the participants was 37.93 ± 13.73 years, with a male-to-female ratio of 1.53:1. The prevalence of toenail infections was significantly higher than that of fingernails. Distal and lateral subungual onychomycosis (DLSO) were the most frequent clinical classifications. PCR results indicated that dermatophytes were the most prevalent pathogens, followed by yeasts and NDMs, among which T. rubrum was the most dominant dermatophyte. TER demonstrated high sensitivity to T. rubrum. However, in clinical settings, some patients with onychomycosis exhibit a poor response to TER treatment. The relationship between in vitro antifungal sensitivity and clinical effectiveness is complex, and understanding the link between in vitro MIC values and clinical efficacy requires further investigation.

Onychomycosis is the most frequent nail disorder, but unfortunately, curative treatment is still a challenge, and commonly the infection recurs. A widely disseminated system to accurately assess and classify the severity of this disease, such as the MASI score for melasma or PASI for psoriasis, is lacking in the literature. In 2011, Carney et al. established and successfully validated the Onychomycosis Severity Index (OSI), proving it to be a simple and reproducible tool. To validate the Onychomycosis Severity Index in a Brazilian population. Four experienced dermatologists were taught how to use the OSI system, and then evaluated photographs of 24 nails. There was no consultation between the dermatologists, and the results were evaluated by an impartial third party. A statistically significant (p<0.001) high degree of agreement was observed between the evaluators and overall OSI score (mild, moderate or severe) as well as its subcategories (area of involvement, proximity to the nail matrix and presence of dermatophytoma or hyperkeratosis). OSI is a very useful tool to improve the clinical assessment of onychomycosis and support clinical trial inclusion criteria (p<0.001). It also provides important prognostic data and allows for a better follow-up of treatment efficacy.

UNASSIGNED: Onychomycosis is the most frequently diagnosed nail condition in clinical practice. With the growing popularity of TikTok and online health information-seeking behavior, it is imperative to understand onychomycosis-related content on this platform.
UNASSIGNED: Our objective was to assess content and quality of the most popular onychomycosis-related content on TikTok.
UNASSIGNED: We queried TikTok for videos using the search terms \"onychomycosis\" and \"nail fungus\" for the top 100 videos by view count, with DISCERN scoring used to rate videos for quality.
UNASSIGNED: Average DISCERN score was 1.77 and dermatologists posted videos with the highest mean score (2.56). Most of the videos were educational (72%) and/or related to treatment (69%). Home remedies were recommended more often (58%) than FDA-approved therapies (7%). Physician versus nonphysician posted videos had higher mean DISCERN score (2.28 vs. 1.44) (p < 0.001), greater view number (1,209,953 vs. 343,993) (p < 0.05), and more often discussed medical therapy (p < 0.05).
UNASSIGNED: While social media is a valuable resource for providing medical information to an interminable audience, there are significant shortcomings. Therefore, we recommend that dermatologists advise patients against relying on social media for medical information and consider using social media to provide accessible evidence-based health education on onychomycosis.

UNASSIGNED: Onychomycosis represents half of nail disorders seen in clinical practice. Despite its high prevalence, a bibliometric analysis has not been performed. We aimed to identify the top 100 highly cited onychomycosis publications over the last 50 years to better understand research trends.
UNASSIGNED: SCOPUS was searched for onychomycosis publications, using \"onychomycosis\" and \"nail fungus\" 1/1/1972-12/31/22 on 3/25/23. Top 100 highly cited publications were recorded and ranked by total citation count.
UNASSIGNED: Total citation count was 13,456, with the top 10 articles with highest citation count/year having average 28.7 citations/year. Most articles were published in high IF journals. From 1982 to 2011 (no treatment articles - 1972-1981), there was an 8.6% increase in articles discussing treatment. Overall, 42% of first authors were female.
UNASSIGNED: We found an overall increase in articles discussing onychomycosis therapies over time, with the majority published in high IF journals. We also found a relatively greater percentage of female first authors compared to studies on other dermatologic topics. While total citation count remains a widely used metric of impact in bibliometric studies, average citation count/year may be a better measure of impact and should be considered in future studies.

Die Onychomykose ist eine Pilzinfektion des Nagelorgans und betrifft sowohl Finger- als auch Zehennägel. Sie wird in Europa vor allem durch Dermatophyten verursacht. Die Diagnostik erfolgt mittels direktmikroskopischer, kultureller und/oder molekularer Methoden aus Nagelmaterial (Nagelspäne). Eine Lokaltherapie mit antimykotischem Nagellack wird bei leichten oder mäßig ausgeprägten Nagelinfektionen empfohlen. Bei mittelschwerer und schwerer Onychomykose wird empfohlen - falls keine Kontraindikationen bestehen - stets oral (systemisch) zu behandeln. Eine antimykotische Kombinationstherapie - oral und topisch - sollte dabei angestrebt werden. Ziel dieser Aktualisierung der deutschen S1-Leitlinie ist es, Auswahl und Durchführung von geeigneter Diagnostik und Therapie zu vereinfachen. Die Leitlinie wurde unter Berücksichtigung aktueller internationaler Leitlinien und den Ergebnissen einer Literaturrecherche durch die Experten der Leitlinienkommission erstellt. Die Leitlinienkommission besteht aus Mandatsträgern der Deutschen Dermatologischen Gesellschaft (DDG), des Berufsverbandes der Deutschen Dermatologen (BVDD), der Deutschsprachigen Mykologischen Gesellschaft (DMykG), der Deutschen Gesellschaft für Hygiene und Mikrobiologie (DGHM), der Deutschen Gesellschaft für Kinder- und Jugendmedizin e.V. (DGKJ), der Arbeitsgemeinschaft pädiatrische Dermatologie (APD) und der deutschen Gesellschaft für Pädiatrische Infektiologie (DGPI). Methodisch wurde die Leitliniengruppe durch die Division of Evidence-based Medicine (dEBM) begleitet. Die Leitlinie wurde nach einem umfangreichen internen und externen Review durch die beteiligten Fachgesellschaften freigegeben.

UNASSIGNED: Antigen presentation and antimicrobial immune responses involve the human leukocyte antigen (HLA) system. Onychomycosis is primarily caused by dermatophytes and affects around 5.5% of the population worldwide. Yet, only limited data exist on the associations between the HLA system and onychomycosis. Thus, the objective of the study was to investigate if there is an association between HLA alleles and onychomycosis.
UNASSIGNED: Participants in the Danish Blood Donor Study were defined as cases of onychomycosis and controls based on antifungal prescriptions in the national prescription registry. Associations were investigated using logistic regressions adjusted for confounders and were Bonferroni corrected for multiple tests.
UNASSIGNED: A total of 3,665 participants were considered onychomycosis cases, and 24,144 participants were considered controls. We found two protective HLA alleles of onychomycosis: DQB1*06:04, odds ratios (OR) 0.80 (95% confidence interval (CI) 0.71-0.90), and DRB1*13:02, OR 0.79 (95% CI: 0.71-0.89).
UNASSIGNED: The finding of two novel protective alleles of onychomycosis indicates that certain HLA alleles have certain antigen presentation properties affecting the risk of fungal infection. These findings may provide the basis for future research identifying immunologically relevant antigens of fungi causing onychomycosis, which could ultimately lead to targets of new drugs with antifungal effects.

Onychomycosis is a fungal infection of the fingernails and toenails. In Europe, tinea unguium is mainly caused by dermatophytes. The diagnostic workup comprises microscopic examination, culture and/or molecular testing (nail scrapings). Local treatment with antifungal nail polish is recommended for mild or moderate nail infections. In case of moderate to severe onychomycosis, oral treatment is recommended (in the absence of contraindications). Treatment should consist of topical and systemic agents. The aim of this update of the German S1 guideline is to simplify the selection and implementation of appropriate diagnostics and treatment. The guideline was based on current international guidelines and the results of a literature review conducted by the experts of the guideline committee. This multidisciplinary committee consisted of representatives from the German Society of Dermatology (DDG), the German-Speaking Mycological Society (DMykG), the Association of German Dermatologists (BVDD), the German Society for Hygiene and Microbiology (DGHM), the German Society of Pediatric and Adolescent Medicine (DGKJ), the Working Group for Pediatric Dermatology (APD) and the German Society for Pediatric Infectious Diseases (DGPI). The Division of Evidence-based Medicine (dEBM) provided methodological assistance. The guideline was approved by the participating medical societies following a comprehensive internal and external review.

Onychomycosis is a common disease with a significant negative impact on quality of life. While the disease is usually manageable in general practice, a proportion of patients need specialist treatment in academic hospital clinics. However, it is an unknown question whether the incidence in those needing specialist treatments is changing. Furthermore, the comorbidity burden in this patient population severely affected by onychomycosis has never been characterized. We conducted a retrospective study on patients treated for onychomycosis in Danish hospitals from 1994 to 2018. The cohort was observed for 24 years, and the data comprise 7.2 million Danes and their hospital diagnoses. A disease trajectory algorithm was used to examine the comorbidity burden in the cohort. A total of 2,271 patients received hospital treatment for onychomycosis during the time period, of which 1358 (59.8%) were men. The data show an increase in the incidence of hospital-treated cases since 2012 and that the most common comorbidities in this patient population include cardiovascular disease, alcohol-related diagnoses, and diabetes. One explanation of the increase in specialist treatment may include a general increase in patients with decreased resilience to fungal disease. This lack of resilience may both include an increasing elderly population with atherosclerosis, diabetes, and immunosuppression but also a potential increase in patients treated with immunosuppressive agents. Another possible explanation may include a shift in patient expectations in the case of treatment failure. Thus, patients may have an increasing demand for specialist treatment. While our data document an increase in the number of patients in need of specialist treatment for onychomycosis, we suggest future research to examine the general incidence of onychomycosis but also whether this increase in an apparently recalcitrant disease may be attributed to increased antifungal resistance, more specialist treatment options, or increased attention to dermatomycoses.

UNASSIGNED: Nail changes in people living with human immunodeficiency virus (HIV) have been scarcely reported. The aim of this study was to establish the frequency and characteristics of nail alterations observed in adults with HIV infection in a third-level hospital in Mexico.
UNASSIGNED: Observational and cross-sectional study carried out in 205 patients receiving care at the HIV/AIDS Clinic of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ) in Mexico City. We performed a nail and iconographic assessment of both hands and toenails. We collected information of demographic and clinical variables, as well as drugs use, and antiretroviral treatment used by the participants through a questionnaire and from medical records. We performed direct cytological examinations and nail mycological cultures in participants with symptoms of onychomycosis.
UNASSIGNED: The participants were predominantly male patients (91.2%), with a mean age of 41 (range 21-78) years, under antiretroviral therapy (91.2%), with a suppressed viral load (78.5%) and mean CD4+ lymphocyte count of 379.5 (range 20-1,162) cells/μL. Fitzpatrick\'s IV phototype was prevailing in the studied population (70%). Nail changes were documented in 72.2% of the patients; being pigmentary changes (37.1%) and trauma (30.7%) the most frequent. Onychomycosis was observed in 26.3%; with total dystrophic onychomycosis as the most frequent clinical variant (68.5%). We obtained fungal isolates in 59.3% of participants and Candida parapsilosis was the most frequent of these (37.5%).
UNASSIGNED: We observed a high prevalence of nail changes with very diverse etiology, as well as a variety of nondermatophytic yeasts and molds isolates associated with cases with onychomycosis. These findings reinforce and confirm the need for routine nail examination and stress the importance of medical personnel working with people living with HIV to have broad knowledge of nail pathology.

UNASSIGNED: The etiological agents of onychomycosis are dermatophyte fungi, nondermatophyte filamentous fungi (NDFF), and yeasts. Nail clippings are an accurate tool for diagnosing onychomycosis. The objective of this study was to correlate the characteristics of fungi observed in nail clipping examinations with the results for agents isolated in culture, indicating whether the fungus found on microscopy is a dermatophyte, NDFF, or yeast.
UNASSIGNED: An observational descriptive study of onychomycosis nail clippings stained with PAS comparing culture results with microscopic criteria of fungi morphology, arrangement/orientation, and location of organisms in the nail and presence of neutrophils, serous lakes, and bacterial colonies was conducted.
UNASSIGNED: Thirty-three nail clippings from 29 participants were analyzed. A statistically significant correlation (p < 0.05) was found between smooth/thin/long hyphae with a \"combed\" pattern and dermatophyte agents (sensitivity 89.4%, specificity 91.5%), and between irregular/thick/short anarchic distributed hyphae and nondermatophytes (sensitivity 61.5%, specificity 89.4%). No statistical association with region where fungi were in the nail or with the presence of neutrophils, serous lakes or bacteria was found. Small, rounded, yeast-like organisms correlated with Candida infection.
UNASSIGNED: Although not a substitute for culture, microscopic analysis of fungal structures offers good accuracy for differentiating agents of onychomycosis.