Materiały źródłowe

• #1 Onychomycosis: Diagnosis and management – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/onychomycosis-diagnosis-and-management/

  Onychomycosis is a common condition affecting 5.5% of the population worldwide and represents 20-40% of all onychopathies and about 30% of cutaneous mycotic infections. […] The prevalence of onychomycosis is determined by age, occupation, climate, and frequency of travel. Increase in the aged population, HIV infection or immunosuppressive therapy, avid sports participation, commercial swimming pools, and occlusive foot wear are responsible for an increased incidence. […] Men are affected more frequently possibly due to more frequent nail damage from sports and leisure activities. […] Toe nails are about seven times more frequently affected than fingernails due to three times slower growth rate. […] Walking barefoot, wearing ill-fitting shoes, nail biting (onychophagia), and working with chemicals further predispose Indian patients to onychomycosis.

• #1 Onychomycosis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1105828-overview

  The proliferation of fungal infections in the United States over the past few decades may be traceable to the large immigration of dermatophytes, especially T rubrum, from West Africa and Southeast Asia to North America and Europe. The incidence of OM in particular has been increasing, owing to such factors as diabetes, immunosuppression, and increasing age. […] OM accounts for half of all nail disorders and is the most common nail disease in adults. Toenails are much more likely to be infected than fingernails. About 30% of patients with a cutaneous fungal infection also have OM. The global prevalence of onychomycosis has been estimated at 5.5%. […] Adults are 30 times more likely to have OM than children are. OM has been reported to occur in 2.6% of children younger than 18 years but in as many as 90% of elderly people. Elderly people are more likely to have infections caused by nondermatophyte molds and yeasts. […] Although OM affects males more commonly than females, candidal infections and nondermatophyte mold infections are more common in women than in men. OM affects persons of all races.

• #1 Onychomycosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441853/

  Onychomycosis is a common infection that is increasing in incidence. […] Prevalence estimates range from 1% to 8%, and the incidence is increasing. […] Risk factors include aging, diabetes, tinea pedis, psoriasis, immunodeficiency, and living with family members with onychomycosis.

• #1 Onychomycosis: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1000/p359.html

  The estimated point prevalence of onychomycosis in North America is up to 13.8% for adults and 0.44% for children and adolescents younger than 18 years. […] Age older than 60 years is an important risk factor because of poor peripheral circulation, suboptimal immune function, slower nail growth, and longer exposure to pathogenic fungi. […] Other risk factors include recurrent nail trauma, tobacco use, and certain comorbidities (diabetes mellitus, obesity, psoriasis, malignancy, HIV, peripheral vascular disease, immunocompromised state).

• #1 Onychomycosis – Wikipedia

  https://en.wikipedia.org/wiki/Onychomycosis

  A 2003 survey of diseases of the foot in 16 European countries found onychomycosis to be the most frequent fungal foot infection and estimated its prevalence at 27%. […] Prevalence was observed to increase with age. In Canada, the prevalence was estimated to be 6.48%. […] Onychomycosis affects approximately one-third of diabetics and is 56% more frequent in people with psoriasis.

• #1 Fungal Nail Infections: Causes and Treatment | Doctor

  https://patient.info/doctor/fungal-nail-infections-pro

  This is one of the most commonly occurring dermatological conditions. International prevalence reports a range from 3-26% worldwide. UK prevalence studies report a range of 3-8% in the UK. The incidence of new cases of onychomycosis (OM) appears to be rising due to the increasing prevalence of diabetes in the population, more frequent incidence of immunosuppression and an ageing population. […] Age – adults are ~30 times more likely than children to suffer the condition. It affects 2.6% of children younger than 18 years. The figure in people over 60 is nearer 20%. […] Diabetes mellitus – one study found that clinical onychomycosis was found in 162 of 321 patients with type 2 diabetes mellitus. […] The prognosis is variable and depends on the type of infection as well as host factors such as comorbidities and age. Meta-analyses report mycotic cure rates of 76% for terbinafine, 63% for itraconazole with pulse dosing, 59% for itraconazole with continuous dosing and 48% for fluconazole.

• #1 Incidence and Epidemiology of Onychomycosis in Patients Visiting a Tertiary Care Hospital in India | MDedge

  https://mdedge.com/cutis/article/96294/hair-nails/incidence-and-epidemiology-onychomycosis-patients-visiting-tertiary

  Onychomycosis is a chronic fungal infection of the nails that is largely underdiagnosed in developing countries such as India due to poor health care facilities. […] The incidence of onychomycosis ranges from 0.5% to 5% in the general population in India. […] The incidence is particularly high in warm humid climates such as India. […] Several studies have shown that the prevalence of onychomycosis increases with age, possibly due to poor peripheral circulation, diabetes mellitus, repeated nail trauma, prolonged exposure to pathogenic fungi, suboptimal immune function, inactivity, or inability to trim the toenails and care for the feet. […] Our hospital-based study sought to determine the incidence and epidemiology of onychomycosis with an analysis of 134 participants with clinically suspected onychomycosis.

• #1 Effective treatment of fungal nail infections | Canesten®

  https://www.canesten.com.my/skin-and-foot-health/conditions/fungal-nail

  Globally, nail fungus is the most frequent type of nail fungal infection, and accounts for up to 50% of all nail diseases. […] Changing rooms, public showers and unsterilized equipment in nail salons can put you at an increased risk of a nail fungal infection. […] Remember to wash your hands! Direct physical contact with a person suffering from a nail fungal infection can put you at risk of catching an infection yourself.

• #1 Onychomycosis: Current Trends in Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1201/p762.html

  Onychomycosis occurs in 10% of the general population, 20% of persons older than 60 years, and 50% of those older than 70 years. […] The risk of onychomycosis is 1.9 to 2.8 times higher in persons with diabetes compared with the general population. […] In patients with human immunodeficiency virus infection, the prevalence ranges from 15% to 40%. […] The increased prevalence in older adults is related to peripheral vascular disease, immunologic disorders, and diabetes mellitus. […] Onychomycosis affects toenails more often than fingernails because of their slower growth, reduced blood supply, and frequent confinement in dark, moist environments. […] Despite treatment, the recurrence rate of onychomycosis is 10% to 50% as a result of reinfection or lack of mycotic cure. […] The epidemiology of onychomycosis: possible role of smoking and peripheral arterial disease. […] Toenail onychomycosis: an important global disease burden.

• #1 Over 50 Million Suffer from Fungal Nail Infections

  https://www.asdreports.com/news-1317/over-50-million-suffer-fungal-nail-infections

  DO accounts for around half of all nail diseases in the world, and represents a considerable medical burden. […] The contagious nature of this condition means that DO is often contracted through contact with a contaminated surface. […] For this reason, members of the same household have a greater risk of contracting the infection, and Japan’s high forecast for DO prevalence could be attributed to the country’s traditional practice of walking barefoot in the house, as this practice facilitates spread of DO infection. […] The risk of contracting DO also becomes more common with advancing age, with disease prevalence being almost tripled in individuals over 50 years of age, perhaps due to their immune system naturally weakening. […] Men are also 30% more likely to be infected with DO than women, possibly due to behavioral factors such as higher rates of trauma to the nails of the hands or feet, as a result of physical activity.

• #1 Fungal Nail Infections (Onychomycosis): A Never-Ending Story? | PLOS Pathogens

  https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1004105

  The prevalence of onychomycosis has been reported to be as high as 23% across Europe and 20% in East Asia. […] In North America, the incidence of onychomycosis is up to 14%, with fungal infection responsible for 50% of all nail disease. […] The most prevalent predisposing risk factor for developing onychomycosis is advanced age, which is reported to be 18.2% in patients 60-79 years of age, compared to 0.7% in patients younger than 19 years of age. […] Further, men are up to three times more likely to have onychomycosis than women, though the reasons for this gender difference are not clear. […] Other risk factors include diabetes and conditions contributing to poor peripheral circulation. […] In fact, onychomycosis may represent an important predictor for the development of diabetic foot syndrome and foot ulcers.

• #1 SciELO Brazil – An observational and descriptive study of the epidemiology of and therapeutic approach to onychomycosis in dermatology offices in Brazil An observational and descriptive study of the epidemiology of and therapeutic approach to onychomycos

  https://www.scielo.br/j/abd/a/5nXvB3jS7VD78fGBMhgWNPR/

  The prevalence of onychomycosis in the general population has been estimated to be between 2% and 9%. […] These numbers have increased considerably in the past decades and are related to diabetes, peripheral arterial disease, psoriasis, immunodepression, and aging. […] Adults are 30 times more likely to have onychomycosis than children. […] Onychomycosis is found in over 90% of the elderly population. […] This is the first epidemiological study on onychomycosis of broad coverage in Brazil. […] In this study, onychomycosis was found in 28.3% of participants. […] Our study has also shown greater prevalence of onychomycosis in women (29.1%). […] The age group most affected by onychomycosis was that of patients aged 60 years, followed by the range between 46 and 59 years. […] Considering the main variables, we noticed that female individuals are 30% more likely to have onychomycosis than male patients; an increase of a category in the age range leads to a 52% increase in the likelihood of being affected by onychomycosis; the risk for patients over 60 years old is 8 times higher than for patients aged between 0 and 17; patients who regularly practice exercises are three times more likely to have onychomycosis than sedentary individuals; prior personal history of the disease increases the likelihood of recurrence by almost 20 times.

• #1 Estimating the Prevalence of Fungal Nail Infections and Potential Concerns for Central Disease Surveillance Hub in Pakistan

  https://www.fortunejournals.com/articles/estimating-the-prevalence-of-fungal-nail-infections-and-potential-concerns-for-central-disease-surveillance-hub-in-pakistan.html

  Nail fungal infections remained unnoticed during COVID-19 pandemic. Herein, we first-time reported national data acquired from 100 branches of IDC Pakistan against Aspergillus species, Penicillium species, Epidermophyton species, Candida species, Candia albicans, Trichophyton species, Bipolaris species or Unidentified fungal infections. […] Our results depicted higher level of nail fungal infections among females as compared to males. There is an urgent need for development of national strategies to monitor fungal infections and designing ways for prevention of fungal disease. […] Current study is critical for constructing novel mechanisms to prevent of fungal infections. This study is not only critical for national policy making or strategic organizations of Pakistan, but also provides guidelines for the accurate determination of fungal infections, surveillance and monitoring of fungal infections worldwide.

• #1 Fungal Nail Infections (Onychomycosis): A Never-Ending Story? | PLOS Pathogens

  https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1004105

  Patients who are immunosuppressed, such as those with HIV infection and those undergoing cancer therapy, are also predisposed to fungal nail infection. […] Toenail onychomycosis is not prevalent in tropical climates, presumably because people in those areas are not in the habit of wearing occlusive footwear that create a warm, moist environment for the proliferation of fungi. […] A recent study by our group utilized regression analysis to show that history of tinea pedis plus three clinical variables—onychomycosis, plantar scaling (a clinical sign of tinea pedis), and nail discoloration (a clinical sign of onychomycosis and generally indicative of severe nail infection)—were statistically associated with spread of infection in households with multiple infected members. […] The treatment of onychomycosis has improved considerably over the past several decades, following the introduction of the oral antifungals terbinafine and itraconazole.

• #1

  https://step2.medbullets.com/dermatology/120060/onychomycosis

  3% prevalence in adults […] 20% prevalence in adults 60 years old […] Risk factors include moist and warm environment, increasing age, immunosuppression, occlusive shoes, and communal baths.

• #1 SciELO Brazil – An observational and descriptive study of the epidemiology of and therapeutic approach to onychomycosis in dermatology offices in Brazil An observational and descriptive study of the epidemiology of and therapeutic approach to onychomycos

  https://www.scielo.br/j/abd/a/5nXvB3jS7VD78fGBMhgWNPR/?lang=en

  Considering the main variables, we noticed that female individuals are 30% more likely to have onychomycosis than male patients; an increase of a category in the age range leads to a 52% increase in the likelihood of being affected by onychomycosis; the risk for patients over 60 years old is 8 times higher than for patients aged between 0 and 17; patients who regularly practice exercises are three times more likely to have onychomycosis than sedentary individuals; prior personal history of the disease increases the likelihood of recurrence by almost 20 times. […] Direct exam was requested of 56.8% patients with onychomycosis. […] Dermatophytes were the most common fungi and Trichophyton rubrum was the most isolated fungus in cultures. […] We also noticed that 41% of patients diagnosed with onychomycosis were also affected by some other comorbidity. […] As for treatment, we observed that a combination of systemic and topical medication, followed by topical monotherapy, was the most common (38.4% and 36.3%, respectively).

• #1 Incidence and Epidemiology of Onychomycosis in Patients Visiting a Tertiary Care Hospital in India | MDedge

  https://community.the-hospitalist.org/content/incidence-and-epidemiology-onychomycosis-patients-visiting-tertiary-care-hospital-india

  Onychomycosis is a chronic fungal infection of the nails. Dermatophytes are the most common etiologic agents, but yeasts and nondermatophyte molds also constitute a substantial number of cases. Onychomycosis affects 5.5% of the world population and represents 20% to 40% of all onychopathies and approximately 30% of cutaneous mycotic infections. […] The incidence of onychomycosis ranges from 0.5% to 5% in the general population in India. The incidence is particularly high in warm humid climates such as India. Researchers have found certain habits of the population in the Indian subcontinent (eg, walking with bare feet, wearing ill-fitting shoes, nail-biting [eg, onychophagia], working with chemicals) to be contributing factors for onychomycosis. Several studies have shown that the prevalence of onychomycosis increases with age, possibly due to poor peripheral circulation, diabetes mellitus, repeated nail trauma, prolonged exposure to pathogenic fungi, suboptimal immune function, inactivity, or inability to trim the toenails and care for the feet.

• #1 Onychomycosis: Epidemiology, clinical features, and diagnosis – UpToDate

  https://www.uptodate.com/contents/onychomycosis-epidemiology-clinical-features-and-diagnosis/print

  Onychomycosis refers to chronic fungal infection of the toenails or fingernails. Causative fungi include dermatophytes, yeasts, and nondermatophyte molds. […] The epidemiology, clinical features, and diagnosis of onychomycosis will be reviewed here (algorithm 1). Other causes of nail dystrophy and the management of onychomycosis are reviewed separately. […] Dermatophyte infections (also known as tinea unguium) are most common and are estimated to account for 60 to 70 percent of infections. Nondermatophyte mold and yeast infections may account for 30 to 40 percent and 10 to 20 percent of fungal nail infections, respectively. […] In a review of multinational hospital-based prevalence studies, in which dermatophytes were found in 65 percent of cases of onychomycosis (including 82 percent of cases in North America), T. rubrum infection was most common, accounting for approximately 45 percent of infections.

• #1 Onychomycosis: Old and New

  https://www.mdpi.com/2309-608X/9/5/559

  Onychomycosis is a chronic fungal infection of the nail that results in discoloration, onycholysis, and nail plate thickening. The infection most commonly occurs in the toenails and can involve any component of the nail unit, including the nail bed, nail matrix, and nail plate. Onychomycosis affects patients of all ages. However, several studies have established higher prevalence with older age. Other risk factors include diabetes, tinea pedis, poor circulation, immunosuppression, psoriasis, Down syndrome, occlusive footwear, and obesity. […] The worldwide prevalence of onychomycosis is estimated at 10% and accounts for up to 50% of nail diseases. Dermatophytes are a common culprit of onychomycosis, with the species Trichophyton rubrum and Trichophyton mentagrophytes responsible for 60–70% of infections. Yeasts are responsible for approximately 20% of onychomycosis, and non-dermatophytes account for the remaining 10%. Studies have demonstrated that mixed infections, non-dermatophytes, and yeasts are more prevalent than previously thought, especially in warmer climates.

• #1 Fungal Nail Infections (Onychomycosis): A Never-Ending Story? | PLOS Pathogens

  https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1004105

  However, these drugs may have side effects such as liver damage or drug interactions, which are particularly relevant in the elderly population. […] Unfortunately, currently available topical agents, such as amorolfine 5% and ciclopirox 8%, have low efficacy (approximately 5%-12%). […] This low efficacy can mainly be attributed to the inability of the drug to penetrate through the nail plate to the nail bed where the infection resides. […] Many different approaches to solving the problem of nail penetration have been attempted recently. […] Recent device-based therapies for onychomycosis include laser devices, photodynamic therapy, iontophoresis, and ultrasound. […] There are multiple factors that may contribute to the high rate of fungal nail infection recurrence. […] Patients with a genetic predisposition to onychomycosis, who are immunocompromised, or who have diabetes, are likely to experience relapse and may never achieve a permanent cure. […] It has long been suspected that nail infections were spread by close contact with family members. […] However, it wasn’t until recently that our group was able to employ molecular techniques to prove that persons within the same household were infected by the same strain of T. rubrum.

• #1 State-of-the-Art Dermatophyte Infections: Epidemiology Aspects, Pathophysiology, and Resistance Mechanisms

  https://www.mdpi.com/2309-608X/7/8/629

  The burden of fungal infections is not widely appreciated. Although these infections are responsible for over one million deaths annually, it is estimated that one billion people are affected by severe fungal diseases. Mycoses of nails and skin, primarily caused by fungi known as dermatophytes, are the most common fungal infections. Trichophyton rubrum appears to be the most common causative agent of dermatophytosis, followed by Trichophyton interdigitale. An estimated 25% of the world’s population suffers from dermatomycosis. […] The increased frequency of dermatophytosis is due to several factors, such as the use of occlusive footwear, inadequate hygiene, socioeconomic status, occupation, climate change, predisposing factors (such as immunosuppression/deficiency and diabetes), and improvements in diagnostic tests and medical care. In recent years, an epidemic-like dermatophytosis scenario has been observed in India. The prevalence of dermatophytosis ranges from 6.09% to 61.5%, depending on the region, with the highest prevalence reported in the North.

• #1 Over 50 Million Suffer from Fungal Nail Infections

  https://www.asdreports.com/news-1317/over-50-million-suffer-fungal-nail-infections

  Over 50 Million Suffer from Fungal Nail Infections Fungal nail infections pose a global health threat, with over 50 million people suffering from the contagious condition last year, states a new report by research. The new report predicts that prevalent cases of dermatophytic onychomycosis (DO) across US, France, Germany, Italy, Spain, UK, and Japan will increase by a further 15% over the next decade, from 51.50 million cases in 2012 to 59.17 million cases by 2022. Epidemiologists forecast that the US alone will see prevalent cases of DO rise from 31.66 million cases in 2012 to 37.69 million cases by 2022, following a 19.1% increase over the next decade. The prevalence of DO in the general population across the US, France, Germany, Italy, Spain, and the UK currently ranges from between 2% and 12%.

• #1 We should take fungal infections more seriously. Here’s why – NICD

  https://www.nicd.ac.za/we-should-take-fungal-infections-more-seriously-heres-why/

  Researchers have raised concerns about anti-fungal resistance. […] The advocacy group Global Action Fund for Fungal Infections estimates that fungal diseases cause between 1.5 million and 2 million deaths every year. […] One of the biggest concerns around life-threatening fungal diseases is that they cause a largely silent epidemic. […] For instance, the World Health Organization has recently decided to monitor anti-fungal resistance using its global surveillance system. […] The countrys National Institute for Communicable Diseases monitors trends in certain serious fungal diseases and provides technical assistance to investigate and respond to outbreaks. […] South Africas Essential Medicines List also recognises the severity of these diseases it includes important medicines needed for treatment of fungal infections in communities and hospitals.

• #1 Estimating the Prevalence of Fungal Nail Infections and Potential Concerns for Central Disease Surveillance Hub in Pakistan – Best Diagnostic Center & Medical Centre in Pakistan -IDC Pvt.LTD

  https://idc.net.pk/estimating-the-prevalence-of-fungal-nail-infections-and-potential-concerns-for-central-disease-surveillance-hub-in-pakistan/

  Fungal nail infections are major public health problem worldwide. It has been reported that globally, each year; more than 300 million people of all ages suffer from serious fungal infections. Due to rising global burden of diseases, the international funding on fungal infection related projects were limited, especially during the pandemic. It has been reported that 185 countries had inadequate national data repository or no surveillance center for fungal infections. Since decades the area of fungal disease has remained neglected due to negligence of healthcare professionals or policymakers in Pakistan. To date, more than 3.2 million people are living with fungal infections in Pakistan. During the first four waves of SARS-CoV-2 infections during 2019-2022, out-patient department patient flow was deliberately reduced by health professionals causing negligence of other infections burden regionally.

• #1 Estimating the Prevalence of Fungal Nail Infections and Potential Concerns for Central Disease Surveillance Hub in Pakistan

  https://fortuneonline.org/articles/estimating-the-prevalence-of-fungal-nail-infections-and-potential-concerns-for-central-disease-surveillance-hub-in-pakistan.html

  Nail fungal infections remained unnoticed during COVID-19 pandemic. […] Our results depicted higher level of nail fungal infections among females as compared to males. There is an urgent need for development of national strategies to monitor fungal infections and designing ways for prevention of fungal disease. […] The study is not only critical for national policy making or strategic organizations of Pakistan, but also provides guidelines for the accurate determination of fungal infections, surveillance and monitoring of fungal infections worldwide.

• #1 Clinical Overview of Ringworm and Fungal Nail Infections | Ringworm | CDC

  https://www.cdc.gov/ringworm/hcp/clinical-overview/index.html

  Onychomycosis (fungal nail infection often associated with dermatophytes) occasionally leads to serious secondary bacterial infections, especially in people with diabetes. […] Antimicrobial-resistant ringworm and onychomycosis are an emerging public health concern. […] Onychomycosis is estimated to affect around 14% of the general population and is especially common in older adults. People with diabetes are at increased risk for fungal nail infections. […] Antimicrobial-resistant ringworm is emerging and is a current public health concern.

• #1

  https://link.springer.com/article/10.1007/s00403-021-02299-8

  Little is known about the relationship of COVID-19 outcomes with onychomycosis. […] Onychomycosis was a significant independent risk factor for COVID-19 severity, hospitalization, and receiving supplemental oxygen therapy. […] This study identified onychomycosis as a significant independent risk factor for multiple poor COVID-19 related clinical outcomes, including being hospitalized, higher acuity level of initial care, requiring supplemental oxygen therapy, and experiencing severe disease. […] Our findings suggest that patients with onychomycosis have poor COVID-19 outcomes. […] In conclusion, the present study suggests that onychomycosis is an indicator of more severe COVID-19 and poor outcomes.

• #1 Estimating the Prevalence of Fungal Nail Infections and Potential Concerns for Central Disease Surveillance Hub in Pakistan – Best Diagnostic Center & Medical Centre in Pakistan -IDC Pvt.LTD

  https://idc.net.pk/estimating-the-prevalence-of-fungal-nail-infections-and-potential-concerns-for-central-disease-surveillance-hub-in-pakistan/

  Estimating the Prevalence of Fungal Nail Infections and Potential Concerns for Central Disease Surveillance Hub in Pakistan […] Nail fungal infections remained unnoticed during COVID-19 pandemic. Herein, we first-time reported national data acquired from 100 branches of IDC Pakistan against Aspergillus species, Penicillium species, Epidermophyton species, Candida species, Candia albicans, Trichophyton species, Bipolaris species or Unidentified fungal infections. Among 497 participants, 22.22% of infections were of Aspergillus species. However, 4.17% of infections were of Candida species and Epidermophyton. The penicillium and Candida albicans species were prevalent at 2.7% among suspected people. However the prevalence of bipolaris species were 1.38%. The unidentified species were also 1.38% among suspected patients, which is potential point of concern. Our results depicted higher level of nail fungal infections among females as compared to males. There is an urgent need for development of national strategies to monitor fungal infections and designing ways for prevention of fungal disease.

• #1 Onychomycosis: Diagnosis and management – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/onychomycosis-diagnosis-and-management/

  Involvement of molds should be suspected in the absence of tinea pedis, history of trauma, presence of one or two affected toe-nails with periungual inflammation. […] The clinical presentation of onychomycosis may provide clues to the infecting organism; however, at times, appearance caused by different fungal species may be indistinguishable. […] It is important to identify the causative fungus before initiating treatment, because some therapies are more effective against certain organisms than others. […] Proper specimen collection is essential to avoid false negative results and to eliminate contaminants. […] Direct microscopy is the quickest and easiest technique to confirm fungal nail infection. […] Culture is essential for confirming the diagnosis and ascertaining the exact etiologic fungus.

• #1 Ringworm and Fungal Nail Infections Basics | Ringworm | CDC

  https://www.cdc.gov/ringworm/about/index.html

  Nail infections (onychomycosis) may cause nails to change colors, become thick, and break easily. […] Ringworm is a common type of fungal nail infection (onychomycosis). It can cause nails to change colors, become thick, and break easily. […] Healthcare providers may take a small skin scraping or nail sample for testing. […] The treatment for ringworm depends on its location on the body and how serious the infection is. Some forms of ringworm can be treated with non-prescription (over-the-counter) antifungal medications. However, other forms of ringworm need treatment with prescription antifungal medication. […] Fungal diseases and antifungal resistance are increasing worldwide. Misdiagnosis is common.

• #1 The information – fungal nail infection – Pulse Today

  https://www.pulsetoday.co.uk/clinical-feature/clinical-areas/dermatology-and-wound-care/the-information-fungal-nail-infection/

  In the UK the prevalence of fungal nail infections is roughly 3%. […] Fungal nail infections, or onychomycosis, have three patterns. […] All possible fungal infections should be confirmed by generous clippings of nail and subungual debris for microscopy and culture prior to starting systemic treatment. […] A recent survey from Europe showed this was undertaken by only 3.4% of primary care physicians and roughly 40% of dermatologists. […] The risks of misdiagnosing fungal nail infections are significant. […] Diagnosis is made through clinical appearance matched with positive microscopy and culture of nail clippings. […] Fungal nail disease has been documented in patterns within families that would be consistent with transmission within the home or shared genetic disposition. […] There are two main topical treatments, amorolfine 5% and tioconazole 28% suitable in DLSO of the distal third and superficial infection (SWO). […] Systemic treatment has higher efficacy but also greater risk. […] In head to head trials oral terbinafine is superior to oral itraconazole.

• #1 Incidence and Epidemiology of Onychomycosis in Patients Visiting a Tertiary Care Hospital in India | MDedge

  https://community.the-hospitalist.org/content/incidence-and-epidemiology-onychomycosis-patients-visiting-tertiary-care-hospital-india

  Of 134 suspected cases of onychomycosis, 71.6% were confirmed by both direct microscopy and fungal culture, but only 56.7% were confirmed by direct microscopy alone. If we had relied on microscopy with potassium hydroxide only, we would have missed 23.9% of cases. Therefore, nail scrapings should always be subjected to fungal culture as well as direct microscopy, as both are necessary for accurate diagnosis and treatment of onychomycosis.

• #1 Incidence and Epidemiology of Onychomycosis in Patients Visiting a Tertiary Care Hospital in India | MDedge

  https://blogs.the-hospitalist.org/content/incidence-and-epidemiology-onychomycosis-patients-visiting-tertiary-care-hospital-india

  Of 134 suspected cases of onychomycosis, 71.6% were confirmed by both direct microscopy and fungal culture, but only 56.7% were confirmed by direct microscopy alone. If we had relied on microscopy with potassium hydroxide only, we would have missed 23.9% of cases. Therefore, nail scrapings should always be subjected to fungal culture as well as direct microscopy, as both are necessary for accurate diagnosis and treatment of onychomycosis.

• #1 Fungal Nail Infections| Fungal Diseases | CDC

  http://medbox.iiab.me/modules/en-cdc/www.cdc.gov/fungal/nail-infections.html

  Fungal nail infections are common infections of the fingernails or toenails that can cause the nail to become discolored, thick, and more likely to crack and break. Infections are more common in toenails than fingernails. The technical name for a fungal nail infection is onychomycosis. […] Anyone can get a fungal nail infection. Some people may be more likely than others to get a fungal nail infection, including older adults and people who have the following conditions: A nail injury or nail surgery, Diabetes, A weakened immune system, Blood circulation problems, Athlete’s foot (ringworm on the foot). […] Onychomycosis can be classified into several subtypes based on the origin of the infection within the nail plate, the infecting organism, or the appearance of the nail. […] Diagnosis of onychomycosis can often be made by visual inspection alone; laboratory tests may not be needed, but include: Microscopy: Potassium hydroxide (KOH) stain is a commonly-used method because it is inexpensive and easy to perform. Nail clippings or scrapings are placed in a drop of KOH and examined under a microscope for the presence of fungal elements. […] Oral terbinafine is considered to be the first-line treatment for confirmed onychomycosis; the treatment course is generally 6 weeks for fingernails and 12 weeks for toenails.

• #1 Onychomycosis: Diagnosis and management – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/onychomycosis-diagnosis-and-management/

  NDM grow faster than dermatophytes and produce well-formed colonies within 1 week. […] Though considered gold standard for diagnosis, culture takes a longer time and yield of positive culture is often disappointing. […] Various improvisations have been adopted for sample collection to improve fungal yield. […] Histopatholgy of nail specimens may be necessary when KOH and culture are repeatedly negative in patients with suspected onychomycosis. […] Other less frequently used tests to diagnose onychomycosis include immunohistochemistry and dual flow cytometry especially for identifying mixed infections and for quantification of fungal load in the nail. […] Despite the availability of various treatment modalities for onychomycosis, the search for an ideal antifungal drug is going on.

• #1 Onychomycosis: Old and New

  https://www.mdpi.com/2309-608X/9/5/559

  Onychomycosis is challenging to treat and is associated with high recurrence rates and treatment failure. Given the limited cure rates with topical antifungals, oral antifungals may be needed in most cases. Oral treatments require lengthy duration of treatment, which poses a risk of adverse effects and drug interactions. Relapse rate can be as high as 25%, and recurrence rates can vary from 6.5% to 53%. Terbinafine and itraconazole are the only approved oral therapies, but fluconazole is commonly utilized off-label. However, complete cure rates (both mycologic clearance and visually clear nails) are limited, and they can range from 35%–55% for terbinafine, 14–43% for itraconazole, and 21–48% for fluconazole. Recently, there are reports of concerning reports of terbinafine resistance in superficial mycoses in India and Europe, and novel agents may play an important role to achieve a cure.

• #1 SciELO Brazil – An observational and descriptive study of the epidemiology of and therapeutic approach to onychomycosis in dermatology offices in Brazil An observational and descriptive study of the epidemiology of and therapeutic approach to onychomycos

  https://www.scielo.br/j/abd/a/5nXvB3jS7VD78fGBMhgWNPR/

  Direct exam was requested of 56.8% patients with onychomycosis. […] Dermatophytes were the most common fungi and Trichophyton rubrum was the most isolated fungus in cultures. […] We also noticed that 41% of patients diagnosed with onychomycosis were also affected by some other comorbidity. […] As for treatment, we observed that a combination of systemic and topical medication, followed by topical monotherapy, was the most common (38.4% and 36.3%, respectively).

• #1 Onychomycosis: Old and New

  https://www.mdpi.com/2309-608X/9/5/559

  Onychomycosis studies often report the mycologic cure, clinical cure, and complete cure rates. A mycologic cure is achieved when both the culture and direct microscopy are negative after medical treatment. A clinical cure is defined as a normal appearance of the affected nail. A complete cure is defined as both negative mycology and absence of clinical signs in the nail. The goal of treatment is complete cure; however, patients often have nail abnormalities before the development of the fungal infections and will not achieve fully normal nails after treatment. In this review, we will focus primarily on complete cure rates. […] Terbinafine resistance is an emerging problem globally, and isolates have been documented in India and Europe with increasing frequency. The Trichophyton species is commonly identified, specifically T. rubrum, T. interdigitale/mentagrophytes, and T. indotineae. Terbinafine inhibits squalene oxidase and interferes with ergosterol production, a compound necessary for fungal plasma membrane structure. Trichophyton resistant cases arise when point mutations develop in the squalene oxidase gene. While cases of antifungal resistance have been largely reported in dermatophytic infections of the skin, the emergence and spread of these organisms is an important public health concern that can have significant consequences in onychomycosis cases.

• #1

  https://www.dermatophytes.reviberoammicol.com/contents.php?122135

  Epidemiology of nail infection due to keratinophilic fungi […] The epidemiology of fungal infections of the nails, or onychomycosis, is only partially known since it is a combination of different factors which include, among others, the etiological agent, the clinical form of the infection, the patient’s background, other parameters related to the physiology and ecology of the causative fungi, and even the habits of the population. […] Although there is the belief that onychomycosis has increased its presence, especially in developed countries, the data available on its prevalence is limited and varies considerably according to the origin of the publication and the study method. […] Consideration is given to the factors favouring infection, the low incidence of this mycosis among the younger age group, and the social and economic impact of onychomycosis in developed countries.

• #1 (PDF) Epidemiology of nail infection due to keratinophilic fungi

  https://www.academia.edu/83752936/Epidemiology_of_nail_infection_due_to_keratinophilic_fungi

  The epidemiology of fungal infections of the nails, or onychomycosis, is only partially known since it is a combination of different factors which include, among others, the etiological agent, the clinical form of the infection, the patient’s background, other parameters related […] Onychomycosis (fungal nail infection) is caused by three groups of fungal pathogens namely dermatophyte molds (DM), non-DM (NDM) and yeasts. It is primarily a cosmetic problem but may induce impact on quality of life. […] This study identified dermatophytes as the prime cause of onychomycosis, chiefly affecting toenails with DLSO as the predominant form, and recognized trauma as a key risk factor. […] Onychomycosis is a common superficial fungal infection of nail in both developed and developing countries. It may involve any component of the nail unit, including the nail matrix, the nail bed, or the nail plate. It represents up to 20.0% of all nail disorders. Its prevalence is estimated at 2 to 18 percentage worldwide and up to 48-percentage incidence by age 70.

• #1 State-of-the-Art Dermatophyte Infections: Epidemiology Aspects, Pathophysiology, and Resistance Mechanisms

  https://www.mdpi.com/2309-608X/7/8/629

  An epidemiological survey of dermatophytosis in Switzerland from 2001 to 2018 revealed that the main etiological agents isolated from cases of tinea pedis and unguium were T. rubrum and T. interdigitale. […] The occurrence of cutaneous dermatophytosis may also lead to invasive and deep infections. A systematic review of cases of deep dermatophytosis worldwide, from 2000 to 2020, showed that half of the patients presented chronic cutaneous infections at the same anatomical site before invasive lesions. […] The most prevalent dermatophyte, isolated in 53.1% of invasive cases, was T. rubrum, followed by T. mentagrophytes, M. canis, T. tonsurans, T. interdigitale, and T. violaceum.

• #1 Onychomycosis – epidemiology, diagnosis and management

  https://tspace.library.utoronto.ca/handle/1807/53561

  Onychomycosis is a fungal infection of nails caused by dermatophytes, yeasts or nondermatophyte molds and represents about 30% of mycotic cutaneous infections. […] The prevalence rate of onychomycosis is determined by age, predisposing factor, social class, occupation, climate, living environment and frequency of travel. […] Onychomycosis in immunocompromised patients can pose a more serious health problem. […] Dermatophytes are the most frequently implicated causative agents in onychomycosis. […] Clinical diagnosis of onychomycosis is based on the patients history; a physical examination, microscopy and culture of nail specimens.

• #1 Incidence and Epidemiology of Onychomycosis in Patients Visiting a Tertiary Care Hospital in India | MDedge

  https://community.the-hospitalist.org/content/incidence-and-epidemiology-onychomycosis-patients-visiting-tertiary-care-hospital-india

  Our hospital-based study sought to determine the incidence and epidemiology of onychomycosis with an analysis of 134 participants with clinically suspected onychomycosis. […] The isolation rate of onychomycosis in our hospital-based study was 71.6%, which is in accordance with various studies in India and abroad. […] The prevalence of onychomycosis by age also varies. In our study, participants older than 40 years showed the highest prevalence (47.8%), which is in accordance with other studies from India and abroad. […] In our study, suspected onychomycosis was more common in males (58.2%) than in females (41.8%). […] The incidence of onychomycosis was almost evenly distributed among farmers, housewives, and the miscellaneous group, whereas a high isolation rate was noted among students.

• #1 We should take fungal infections more seriously. Here’s why – NICD

  https://www.nicd.ac.za/we-should-take-fungal-infections-more-seriously-heres-why/

  My colleagues and I at the National Institute for Communicable Diseases are trying to work out if this national cryptococcal antigen screen-and-treat programme has reduced deaths from cryptococcal meningitis. […] To combat serious fungal infections, researchers at various institutions are also testing vaccines, new anti-fungal medicines or combinations of medicines in clinical trials.

• #1 (PDF) Epidemiology of nail infection due to keratinophilic fungi

  https://www.academia.edu/83752936/Epidemiology_of_nail_infection_due_to_keratinophilic_fungi

  Onychomycosis remains the most common nail disorder with a significant burden. There is need for prevention through practice of good personal hygiene and prescribed treatment of onychomycosis as it can have a considerable impact on patients’ quality of life. […] Onychomycosis was detected in 11 patients with psoriasis (25.6%) (hand and/or foot), while in 17 patients (39.5%) in control group. There was no statistically significant difference between two groups (p=0.170). […] Onychomycosis, a nail fungus infection is the most frequent nail ailment, constituting about half of all nail disorders. It can be caused by dermatophytes, non-dermatophytes, yeasts and Prothoteca spp. […] The preliminary results of the European Onychomycosis Observatory (EUROO) study were analysed. In this international study, physicians completed questionnaires concerning patient profile and the disease. […] One of the most interesting novel findings was that sampling requests were often not made [only 3.4% of general physicians (GPs) and 39.6% of dermatologists]. This means that no information about causative agent(s) was available, hindering appropriate treatment choice.

• #1 Onychomycosis in the 21st Century: An Update on Diagnosis, Epidemiology, and Treatment

  https://ouci.dntb.gov.ua/en/works/leaQnmEl/

  Onychomycosis accounts for 50% of all nail disease cases and is commonly caused by dermatophytes. […] Across 6 recently published epidemiology studies, the global prevalence of onychomycosis was estimated to be 5.5%, falling within the range of previously reported estimates (2%-8%). […] Onychomycosis is a common disease with a significant negative impact on quality of life. […] 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. […] 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.

• #2 Onychomycosis: Epidemiology, clinical features, and diagnosis – UpToDate

  https://www.uptodate.com/contents/onychomycosis-epidemiology-clinical-features-and-diagnosis/print

  Onychomycosis refers to chronic fungal infection of the toenails or fingernails. Causative fungi include dermatophytes, yeasts, and nondermatophyte molds. […] The epidemiology, clinical features, and diagnosis of onychomycosis will be reviewed here (algorithm 1). Other causes of nail dystrophy and the management of onychomycosis are reviewed separately. […] Dermatophyte infections (also known as tinea unguium) are most common and are estimated to account for 60 to 70 percent of infections. Nondermatophyte mold and yeast infections may account for 30 to 40 percent and 10 to 20 percent of fungal nail infections, respectively. […] In a review of multinational hospital-based prevalence studies, in which dermatophytes were found in 65 percent of cases of onychomycosis (including 82 percent of cases in North America), T. rubrum infection was most common, accounting for approximately 45 percent of infections.

• #2 Onychomycosis: Current Trends in Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1201/p762.html

  Onychomycosis occurs in 10% of the general population, 20% of persons older than 60 years, and 50% of those older than 70 years. […] The risk of onychomycosis is 1.9 to 2.8 times higher in persons with diabetes compared with the general population. […] In patients with human immunodeficiency virus infection, the prevalence ranges from 15% to 40%. […] The increased prevalence in older adults is related to peripheral vascular disease, immunologic disorders, and diabetes mellitus. […] Onychomycosis affects toenails more often than fingernails because of their slower growth, reduced blood supply, and frequent confinement in dark, moist environments. […] Despite treatment, the recurrence rate of onychomycosis is 10% to 50% as a result of reinfection or lack of mycotic cure. […] The epidemiology of onychomycosis: possible role of smoking and peripheral arterial disease. […] Toenail onychomycosis: an important global disease burden.

• #2 Onychomycosis: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1000/p359.html

  The estimated point prevalence of onychomycosis in North America is up to 13.8% for adults and 0.44% for children and adolescents younger than 18 years. […] Age older than 60 years is an important risk factor because of poor peripheral circulation, suboptimal immune function, slower nail growth, and longer exposure to pathogenic fungi. […] Other risk factors include recurrent nail trauma, tobacco use, and certain comorbidities (diabetes mellitus, obesity, psoriasis, malignancy, HIV, peripheral vascular disease, immunocompromised state).

• #2 How to treat fungal nail effectively – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/how-to-treat-fungal-nail-effectively

  Fungal nail infection (onychomycosis [OM]) is a mycotic infection caused by fungal invasion of the nail structure and is one of the most common nail disorders, representing half of nail abnormalities in adults. Its prevalence in Europe is around 4.3% over all age groups and 15.5% of all nail dystrophies in children. OM is more commonly diagnosed in men and older people, affecting 20–50% of people aged over 60 years. An increased incidence among older people may be attributed to multiple factors, including reduced peripheral circulation, diabetes, inactivity, relative immunosuppression, and reduced nail growth and quality. […] The management of OM depends on the type, extent and severity of nail involvement, symptoms and pre-existing conditions. The aim of treatment is to eradicate the pathogen, restore the nail and prevent re-infection. OM is challenging to treat and affected nails may never return to normal as the infection may have caused permanent damage. […] As OM has a high relapse rate of 40–70%, advice on preventative and appropriate self-care strategies to avoid re-infection should be offered to patients.

• #2 Incidence and Epidemiology of Onychomycosis in Patients Visiting a Tertiary Care Hospital in India | MDedge

  https://community.the-hospitalist.org/content/incidence-and-epidemiology-onychomycosis-patients-visiting-tertiary-care-hospital-india

  Onychomycosis is a chronic fungal infection of the nails. Dermatophytes are the most common etiologic agents, but yeasts and nondermatophyte molds also constitute a substantial number of cases. Onychomycosis affects 5.5% of the world population and represents 20% to 40% of all onychopathies and approximately 30% of cutaneous mycotic infections. […] The incidence of onychomycosis ranges from 0.5% to 5% in the general population in India. The incidence is particularly high in warm humid climates such as India. Researchers have found certain habits of the population in the Indian subcontinent (eg, walking with bare feet, wearing ill-fitting shoes, nail-biting [eg, onychophagia], working with chemicals) to be contributing factors for onychomycosis. Several studies have shown that the prevalence of onychomycosis increases with age, possibly due to poor peripheral circulation, diabetes mellitus, repeated nail trauma, prolonged exposure to pathogenic fungi, suboptimal immune function, inactivity, or inability to trim the toenails and care for the feet.

• #2 SciELO Brazil – An observational and descriptive study of the epidemiology of and therapeutic approach to onychomycosis in dermatology offices in Brazil An observational and descriptive study of the epidemiology of and therapeutic approach to onychomycos

  https://www.scielo.br/j/abd/a/5nXvB3jS7VD78fGBMhgWNPR/

  The prevalence of onychomycosis in the general population has been estimated to be between 2% and 9%. […] These numbers have increased considerably in the past decades and are related to diabetes, peripheral arterial disease, psoriasis, immunodepression, and aging. […] Adults are 30 times more likely to have onychomycosis than children. […] Onychomycosis is found in over 90% of the elderly population. […] This is the first epidemiological study on onychomycosis of broad coverage in Brazil. […] In this study, onychomycosis was found in 28.3% of participants. […] Our study has also shown greater prevalence of onychomycosis in women (29.1%). […] The age group most affected by onychomycosis was that of patients aged 60 years, followed by the range between 46 and 59 years. […] Considering the main variables, we noticed that female individuals are 30% more likely to have onychomycosis than male patients; an increase of a category in the age range leads to a 52% increase in the likelihood of being affected by onychomycosis; the risk for patients over 60 years old is 8 times higher than for patients aged between 0 and 17; patients who regularly practice exercises are three times more likely to have onychomycosis than sedentary individuals; prior personal history of the disease increases the likelihood of recurrence by almost 20 times.

• #2 Onychomycosis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1105828-overview

  The proliferation of fungal infections in the United States over the past few decades may be traceable to the large immigration of dermatophytes, especially T rubrum, from West Africa and Southeast Asia to North America and Europe. The incidence of OM in particular has been increasing, owing to such factors as diabetes, immunosuppression, and increasing age. […] OM accounts for half of all nail disorders and is the most common nail disease in adults. Toenails are much more likely to be infected than fingernails. About 30% of patients with a cutaneous fungal infection also have OM. The global prevalence of onychomycosis has been estimated at 5.5%. […] Adults are 30 times more likely to have OM than children are. OM has been reported to occur in 2.6% of children younger than 18 years but in as many as 90% of elderly people. Elderly people are more likely to have infections caused by nondermatophyte molds and yeasts. […] Although OM affects males more commonly than females, candidal infections and nondermatophyte mold infections are more common in women than in men. OM affects persons of all races.

• #2 Fungal Nail Infections: Causes and Treatment | Doctor

  https://patient.info/doctor/fungal-nail-infections-pro

  This is one of the most commonly occurring dermatological conditions. International prevalence reports a range from 3-26% worldwide. UK prevalence studies report a range of 3-8% in the UK. The incidence of new cases of onychomycosis (OM) appears to be rising due to the increasing prevalence of diabetes in the population, more frequent incidence of immunosuppression and an ageing population. […] Age – adults are ~30 times more likely than children to suffer the condition. It affects 2.6% of children younger than 18 years. The figure in people over 60 is nearer 20%. […] Diabetes mellitus – one study found that clinical onychomycosis was found in 162 of 321 patients with type 2 diabetes mellitus. […] The prognosis is variable and depends on the type of infection as well as host factors such as comorbidities and age. Meta-analyses report mycotic cure rates of 76% for terbinafine, 63% for itraconazole with pulse dosing, 59% for itraconazole with continuous dosing and 48% for fluconazole.

• #2 Incidence and Epidemiology of Onychomycosis in Patients Visiting a Tertiary Care Hospital in India | MDedge

  https://mdedge.com/cutis/article/96294/hair-nails/incidence-and-epidemiology-onychomycosis-patients-visiting-tertiary

  Onychomycosis is a chronic fungal infection of the nails that is largely underdiagnosed in developing countries such as India due to poor health care facilities. […] The incidence of onychomycosis ranges from 0.5% to 5% in the general population in India. […] The incidence is particularly high in warm humid climates such as India. […] Several studies have shown that the prevalence of onychomycosis increases with age, possibly due to poor peripheral circulation, diabetes mellitus, repeated nail trauma, prolonged exposure to pathogenic fungi, suboptimal immune function, inactivity, or inability to trim the toenails and care for the feet. […] Our hospital-based study sought to determine the incidence and epidemiology of onychomycosis with an analysis of 134 participants with clinically suspected onychomycosis.

• #2 Over 50 Million Suffer from Fungal Nail Infections

  https://www.asdreports.com/news-1317/over-50-million-suffer-fungal-nail-infections

  DO accounts for around half of all nail diseases in the world, and represents a considerable medical burden. […] The contagious nature of this condition means that DO is often contracted through contact with a contaminated surface. […] For this reason, members of the same household have a greater risk of contracting the infection, and Japan’s high forecast for DO prevalence could be attributed to the country’s traditional practice of walking barefoot in the house, as this practice facilitates spread of DO infection. […] The risk of contracting DO also becomes more common with advancing age, with disease prevalence being almost tripled in individuals over 50 years of age, perhaps due to their immune system naturally weakening. […] Men are also 30% more likely to be infected with DO than women, possibly due to behavioral factors such as higher rates of trauma to the nails of the hands or feet, as a result of physical activity.

• #2 Fungal Nail Infections (Onychomycosis): A Never-Ending Story? | PLOS Pathogens

  https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1004105

  The prevalence of onychomycosis has been reported to be as high as 23% across Europe and 20% in East Asia. […] In North America, the incidence of onychomycosis is up to 14%, with fungal infection responsible for 50% of all nail disease. […] The most prevalent predisposing risk factor for developing onychomycosis is advanced age, which is reported to be 18.2% in patients 60-79 years of age, compared to 0.7% in patients younger than 19 years of age. […] Further, men are up to three times more likely to have onychomycosis than women, though the reasons for this gender difference are not clear. […] Other risk factors include diabetes and conditions contributing to poor peripheral circulation. […] In fact, onychomycosis may represent an important predictor for the development of diabetic foot syndrome and foot ulcers.

• #2

  https://step2.medbullets.com/dermatology/120060/onychomycosis

  3% prevalence in adults […] 20% prevalence in adults 60 years old […] Risk factors include moist and warm environment, increasing age, immunosuppression, occlusive shoes, and communal baths.

• #2 Effective treatment of fungal nail infections | Canesten®

  https://www.canesten.com.my/skin-and-foot-health/conditions/fungal-nail

  Globally, nail fungus is the most frequent type of nail fungal infection, and accounts for up to 50% of all nail diseases. […] Changing rooms, public showers and unsterilized equipment in nail salons can put you at an increased risk of a nail fungal infection. […] Remember to wash your hands! Direct physical contact with a person suffering from a nail fungal infection can put you at risk of catching an infection yourself.

• #2 Fungal Nail Infections (Onychomycosis): A Never-Ending Story? | PLOS Pathogens

  https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1004105

  However, these drugs may have side effects such as liver damage or drug interactions, which are particularly relevant in the elderly population. […] Unfortunately, currently available topical agents, such as amorolfine 5% and ciclopirox 8%, have low efficacy (approximately 5%-12%). […] This low efficacy can mainly be attributed to the inability of the drug to penetrate through the nail plate to the nail bed where the infection resides. […] Many different approaches to solving the problem of nail penetration have been attempted recently. […] Recent device-based therapies for onychomycosis include laser devices, photodynamic therapy, iontophoresis, and ultrasound. […] There are multiple factors that may contribute to the high rate of fungal nail infection recurrence. […] Patients with a genetic predisposition to onychomycosis, who are immunocompromised, or who have diabetes, are likely to experience relapse and may never achieve a permanent cure. […] It has long been suspected that nail infections were spread by close contact with family members. […] However, it wasn’t until recently that our group was able to employ molecular techniques to prove that persons within the same household were infected by the same strain of T. rubrum.

• #2 Clinical Overview of Ringworm and Fungal Nail Infections | Ringworm | CDC

  https://www.cdc.gov/ringworm/hcp/clinical-overview/index.html

  Onychomycosis (fungal nail infection often associated with dermatophytes) occasionally leads to serious secondary bacterial infections, especially in people with diabetes. […] Antimicrobial-resistant ringworm and onychomycosis are an emerging public health concern. […] Onychomycosis is estimated to affect around 14% of the general population and is especially common in older adults. People with diabetes are at increased risk for fungal nail infections. […] Antimicrobial-resistant ringworm is emerging and is a current public health concern.

• #2 Onychomycosis: Diagnosis and management – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/onychomycosis-diagnosis-and-management/

  Other predisposing factors include nail trauma, peripheral vascular disease (PVD), smoking, and psoriasis. […] There is a wide variety of fungi causing onychomycosis which varies from one geographic area to another primarily due to different climatic conditions. […] Dermatophytes are the most frequently implicated causative agents in onychomycosis (approximately 90% in toenail and 50% in fingernail). […] Nondermatophyte molds (NDM) mainly affect toenails and occasionally fingernails. […] NDM account for 1.5-6% of all onychomycosis that fall into two main categories: first group encompasses fungi that are nearly always isolated from nails as etiologic agents, such as Scytalidium dimidiatum and Scytalidium hyalinum; the second group is formed by opportunistic fungi that may also be isolated as contaminants, such as Scopulariopsis brevicaulis, Aspergillus sydowii, and Onychocola canadensis.

• #2 Fungal Nail Infections (Onychomycosis): A Never-Ending Story? | PLOS Pathogens

  https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1004105

  Patients who are immunosuppressed, such as those with HIV infection and those undergoing cancer therapy, are also predisposed to fungal nail infection. […] Toenail onychomycosis is not prevalent in tropical climates, presumably because people in those areas are not in the habit of wearing occlusive footwear that create a warm, moist environment for the proliferation of fungi. […] A recent study by our group utilized regression analysis to show that history of tinea pedis plus three clinical variables—onychomycosis, plantar scaling (a clinical sign of tinea pedis), and nail discoloration (a clinical sign of onychomycosis and generally indicative of severe nail infection)—were statistically associated with spread of infection in households with multiple infected members. […] The treatment of onychomycosis has improved considerably over the past several decades, following the introduction of the oral antifungals terbinafine and itraconazole.

• #2 Onychomycosis: Diagnosis and management – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/onychomycosis-diagnosis-and-management/

  Onychomycosis is a common condition affecting 5.5% of the population worldwide and represents 20-40% of all onychopathies and about 30% of cutaneous mycotic infections. […] The prevalence of onychomycosis is determined by age, occupation, climate, and frequency of travel. Increase in the aged population, HIV infection or immunosuppressive therapy, avid sports participation, commercial swimming pools, and occlusive foot wear are responsible for an increased incidence. […] Men are affected more frequently possibly due to more frequent nail damage from sports and leisure activities. […] Toe nails are about seven times more frequently affected than fingernails due to three times slower growth rate. […] Walking barefoot, wearing ill-fitting shoes, nail biting (onychophagia), and working with chemicals further predispose Indian patients to onychomycosis.

• #2 Onychomycosis: Old and New

  https://www.mdpi.com/2309-608X/9/5/559

  Onychomycosis is a chronic fungal infection of the nail that results in discoloration, onycholysis, and nail plate thickening. The infection most commonly occurs in the toenails and can involve any component of the nail unit, including the nail bed, nail matrix, and nail plate. Onychomycosis affects patients of all ages. However, several studies have established higher prevalence with older age. Other risk factors include diabetes, tinea pedis, poor circulation, immunosuppression, psoriasis, Down syndrome, occlusive footwear, and obesity. […] The worldwide prevalence of onychomycosis is estimated at 10% and accounts for up to 50% of nail diseases. Dermatophytes are a common culprit of onychomycosis, with the species Trichophyton rubrum and Trichophyton mentagrophytes responsible for 60–70% of infections. Yeasts are responsible for approximately 20% of onychomycosis, and non-dermatophytes account for the remaining 10%. Studies have demonstrated that mixed infections, non-dermatophytes, and yeasts are more prevalent than previously thought, especially in warmer climates.

• #2 SciELO Brazil – An observational and descriptive study of the epidemiology of and therapeutic approach to onychomycosis in dermatology offices in Brazil An observational and descriptive study of the epidemiology of and therapeutic approach to onychomycos

  https://www.scielo.br/j/abd/a/5nXvB3jS7VD78fGBMhgWNPR/?lang=en

  Considering the main variables, we noticed that female individuals are 30% more likely to have onychomycosis than male patients; an increase of a category in the age range leads to a 52% increase in the likelihood of being affected by onychomycosis; the risk for patients over 60 years old is 8 times higher than for patients aged between 0 and 17; patients who regularly practice exercises are three times more likely to have onychomycosis than sedentary individuals; prior personal history of the disease increases the likelihood of recurrence by almost 20 times. […] Direct exam was requested of 56.8% patients with onychomycosis. […] Dermatophytes were the most common fungi and Trichophyton rubrum was the most isolated fungus in cultures. […] We also noticed that 41% of patients diagnosed with onychomycosis were also affected by some other comorbidity. […] As for treatment, we observed that a combination of systemic and topical medication, followed by topical monotherapy, was the most common (38.4% and 36.3%, respectively).

• #2 The information – fungal nail infection – Pulse Today

  https://www.pulsetoday.co.uk/clinical-feature/clinical-areas/dermatology-and-wound-care/the-information-fungal-nail-infection/

  In the UK the prevalence of fungal nail infections is roughly 3%. […] Fungal nail infections, or onychomycosis, have three patterns. […] All possible fungal infections should be confirmed by generous clippings of nail and subungual debris for microscopy and culture prior to starting systemic treatment. […] A recent survey from Europe showed this was undertaken by only 3.4% of primary care physicians and roughly 40% of dermatologists. […] The risks of misdiagnosing fungal nail infections are significant. […] Diagnosis is made through clinical appearance matched with positive microscopy and culture of nail clippings. […] Fungal nail disease has been documented in patterns within families that would be consistent with transmission within the home or shared genetic disposition. […] There are two main topical treatments, amorolfine 5% and tioconazole 28% suitable in DLSO of the distal third and superficial infection (SWO). […] Systemic treatment has higher efficacy but also greater risk. […] In head to head trials oral terbinafine is superior to oral itraconazole.

• #2 Estimating the Prevalence of Fungal Nail Infections and Potential Concerns for Central Disease Surveillance Hub in Pakistan

  https://fortuneonline.org/articles/estimating-the-prevalence-of-fungal-nail-infections-and-potential-concerns-for-central-disease-surveillance-hub-in-pakistan.html

  Nail fungal infections remained unnoticed during COVID-19 pandemic. […] Our results depicted higher level of nail fungal infections among females as compared to males. There is an urgent need for development of national strategies to monitor fungal infections and designing ways for prevention of fungal disease. […] The study is not only critical for national policy making or strategic organizations of Pakistan, but also provides guidelines for the accurate determination of fungal infections, surveillance and monitoring of fungal infections worldwide.

• #2 Estimating the Prevalence of Fungal Nail Infections and Potential Concerns for Central Disease Surveillance Hub in Pakistan – Best Diagnostic Center & Medical Centre in Pakistan -IDC Pvt.LTD

  https://idc.net.pk/estimating-the-prevalence-of-fungal-nail-infections-and-potential-concerns-for-central-disease-surveillance-hub-in-pakistan/

  Estimating the Prevalence of Fungal Nail Infections and Potential Concerns for Central Disease Surveillance Hub in Pakistan […] Nail fungal infections remained unnoticed during COVID-19 pandemic. Herein, we first-time reported national data acquired from 100 branches of IDC Pakistan against Aspergillus species, Penicillium species, Epidermophyton species, Candida species, Candia albicans, Trichophyton species, Bipolaris species or Unidentified fungal infections. Among 497 participants, 22.22% of infections were of Aspergillus species. However, 4.17% of infections were of Candida species and Epidermophyton. The penicillium and Candida albicans species were prevalent at 2.7% among suspected people. However the prevalence of bipolaris species were 1.38%. The unidentified species were also 1.38% among suspected patients, which is potential point of concern. Our results depicted higher level of nail fungal infections among females as compared to males. There is an urgent need for development of national strategies to monitor fungal infections and designing ways for prevention of fungal disease.

• #2 We should take fungal infections more seriously. Here’s why – NICD

  https://www.nicd.ac.za/we-should-take-fungal-infections-more-seriously-heres-why/

  Researchers have raised concerns about anti-fungal resistance. […] The advocacy group Global Action Fund for Fungal Infections estimates that fungal diseases cause between 1.5 million and 2 million deaths every year. […] One of the biggest concerns around life-threatening fungal diseases is that they cause a largely silent epidemic. […] For instance, the World Health Organization has recently decided to monitor anti-fungal resistance using its global surveillance system. […] The countrys National Institute for Communicable Diseases monitors trends in certain serious fungal diseases and provides technical assistance to investigate and respond to outbreaks. […] South Africas Essential Medicines List also recognises the severity of these diseases it includes important medicines needed for treatment of fungal infections in communities and hospitals.

• #2 Onychomycosis: Old and New

  https://www.mdpi.com/2309-608X/9/5/559

  Onychomycosis studies often report the mycologic cure, clinical cure, and complete cure rates. A mycologic cure is achieved when both the culture and direct microscopy are negative after medical treatment. A clinical cure is defined as a normal appearance of the affected nail. A complete cure is defined as both negative mycology and absence of clinical signs in the nail. The goal of treatment is complete cure; however, patients often have nail abnormalities before the development of the fungal infections and will not achieve fully normal nails after treatment. In this review, we will focus primarily on complete cure rates. […] Terbinafine resistance is an emerging problem globally, and isolates have been documented in India and Europe with increasing frequency. The Trichophyton species is commonly identified, specifically T. rubrum, T. interdigitale/mentagrophytes, and T. indotineae. Terbinafine inhibits squalene oxidase and interferes with ergosterol production, a compound necessary for fungal plasma membrane structure. Trichophyton resistant cases arise when point mutations develop in the squalene oxidase gene. While cases of antifungal resistance have been largely reported in dermatophytic infections of the skin, the emergence and spread of these organisms is an important public health concern that can have significant consequences in onychomycosis cases.

• #2 (PDF) Epidemiology of nail infection due to keratinophilic fungi

  https://www.academia.edu/83752936/Epidemiology_of_nail_infection_due_to_keratinophilic_fungi

  Onychomycosis remains the most common nail disorder with a significant burden. There is need for prevention through practice of good personal hygiene and prescribed treatment of onychomycosis as it can have a considerable impact on patients’ quality of life. […] Onychomycosis was detected in 11 patients with psoriasis (25.6%) (hand and/or foot), while in 17 patients (39.5%) in control group. There was no statistically significant difference between two groups (p=0.170). […] Onychomycosis, a nail fungus infection is the most frequent nail ailment, constituting about half of all nail disorders. It can be caused by dermatophytes, non-dermatophytes, yeasts and Prothoteca spp. […] The preliminary results of the European Onychomycosis Observatory (EUROO) study were analysed. In this international study, physicians completed questionnaires concerning patient profile and the disease. […] One of the most interesting novel findings was that sampling requests were often not made [only 3.4% of general physicians (GPs) and 39.6% of dermatologists]. This means that no information about causative agent(s) was available, hindering appropriate treatment choice.

• #2 Onychomycosis: Diagnosis and management – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/onychomycosis-diagnosis-and-management/

  Involvement of molds should be suspected in the absence of tinea pedis, history of trauma, presence of one or two affected toe-nails with periungual inflammation. […] The clinical presentation of onychomycosis may provide clues to the infecting organism; however, at times, appearance caused by different fungal species may be indistinguishable. […] It is important to identify the causative fungus before initiating treatment, because some therapies are more effective against certain organisms than others. […] Proper specimen collection is essential to avoid false negative results and to eliminate contaminants. […] Direct microscopy is the quickest and easiest technique to confirm fungal nail infection. […] Culture is essential for confirming the diagnosis and ascertaining the exact etiologic fungus.

• #2 Onychomycosis: Diagnosis and management – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/onychomycosis-diagnosis-and-management/

  In the treatment of onychomycosis, the desired endpoints are mycological, clinical, and complete cure. […] Mycological cure is defined as negative microscopy and culture; clinical cure is defined as a nail without any clinical signs of onychomycosis, whereas complete cure is defined as having both mycological and clinical cure. […] Treatment can be either topical, systemic, or a combination of both. […] Indications for topical monotherapy include involvement limited to distal 50% of nail plate, 3 or 4 nails involvement, no matrix area involvement, superficial white onychomycosis (SWO), in children with thin, fast growing nails, as prophylaxis in patients at risk of recurrence, and patients where oral therapy is inappropriate. […] Oral antifungals used to treat onychomycosis include griseofulvin, azoles including ketoconazole, itraconazole and fluconazole, and allylamine terbinafine.

• #2 (PDF) Epidemiology of nail infection due to keratinophilic fungi

  https://www.academia.edu/83752936/Epidemiology_of_nail_infection_due_to_keratinophilic_fungi

  The epidemiology of fungal infections of the nails, or onychomycosis, is only partially known since it is a combination of different factors which include, among others, the etiological agent, the clinical form of the infection, the patient’s background, other parameters related […] Onychomycosis (fungal nail infection) is caused by three groups of fungal pathogens namely dermatophyte molds (DM), non-DM (NDM) and yeasts. It is primarily a cosmetic problem but may induce impact on quality of life. […] This study identified dermatophytes as the prime cause of onychomycosis, chiefly affecting toenails with DLSO as the predominant form, and recognized trauma as a key risk factor. […] Onychomycosis is a common superficial fungal infection of nail in both developed and developing countries. It may involve any component of the nail unit, including the nail matrix, the nail bed, or the nail plate. It represents up to 20.0% of all nail disorders. Its prevalence is estimated at 2 to 18 percentage worldwide and up to 48-percentage incidence by age 70.

• #2 Onychomycosis in the 21st Century: An Update on Diagnosis, Epidemiology, and Treatment

  https://ouci.dntb.gov.ua/en/works/leaQnmEl/

  Onychomycosis accounts for 50% of all nail disease cases and is commonly caused by dermatophytes. […] Across 6 recently published epidemiology studies, the global prevalence of onychomycosis was estimated to be 5.5%, falling within the range of previously reported estimates (2%-8%). […] Onychomycosis is a common disease with a significant negative impact on quality of life. […] 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. […] 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.

• #2 Fungal Nail Infection: Overview, Causes & Treatments

  https://www.healthline.com/health/fungal-nail-infection

  Fungal nail infections are common and are caused by fungi that live in the environment. […] Fungal infections affect toenails more commonly than fingernails, likely because your toes are usually confined to shoes, where theyre in a warm, moist environment. […] Nail infections occur more often in men than in women, and the infections are found in adults more often than in children. […] Older adults have a high risk for getting fungal nail infections because they have poorer circulation. […] The main complications of a fungal nail infection are: a resurgence of the infection, a permanent loss of the affected nail, a discoloration of the infected nail, the spread of infection to other areas of the body and possibly the bloodstream, the development of a bacterial skin infection called cellulitis. […] Its especially important to see your doctor if you have diabetes and a fungal nail infection.

• #2 State-of-the-Art Dermatophyte Infections: Epidemiology Aspects, Pathophysiology, and Resistance Mechanisms

  https://www.mdpi.com/2309-608X/7/8/629

  The burden of fungal infections is not widely appreciated. Although these infections are responsible for over one million deaths annually, it is estimated that one billion people are affected by severe fungal diseases. Mycoses of nails and skin, primarily caused by fungi known as dermatophytes, are the most common fungal infections. Trichophyton rubrum appears to be the most common causative agent of dermatophytosis, followed by Trichophyton interdigitale. An estimated 25% of the world’s population suffers from dermatomycosis. […] The increased frequency of dermatophytosis is due to several factors, such as the use of occlusive footwear, inadequate hygiene, socioeconomic status, occupation, climate change, predisposing factors (such as immunosuppression/deficiency and diabetes), and improvements in diagnostic tests and medical care. In recent years, an epidemic-like dermatophytosis scenario has been observed in India. The prevalence of dermatophytosis ranges from 6.09% to 61.5%, depending on the region, with the highest prevalence reported in the North.

• #2 We should take fungal infections more seriously. Here’s why – NICD

  https://www.nicd.ac.za/we-should-take-fungal-infections-more-seriously-heres-why/

  My colleagues and I at the National Institute for Communicable Diseases are trying to work out if this national cryptococcal antigen screen-and-treat programme has reduced deaths from cryptococcal meningitis. […] To combat serious fungal infections, researchers at various institutions are also testing vaccines, new anti-fungal medicines or combinations of medicines in clinical trials.

• #2 Over 50 Million Suffer from Fungal Nail Infections

  https://www.asdreports.com/news-1317/over-50-million-suffer-fungal-nail-infections

  Over 50 Million Suffer from Fungal Nail Infections Fungal nail infections pose a global health threat, with over 50 million people suffering from the contagious condition last year, states a new report by research. The new report predicts that prevalent cases of dermatophytic onychomycosis (DO) across US, France, Germany, Italy, Spain, UK, and Japan will increase by a further 15% over the next decade, from 51.50 million cases in 2012 to 59.17 million cases by 2022. Epidemiologists forecast that the US alone will see prevalent cases of DO rise from 31.66 million cases in 2012 to 37.69 million cases by 2022, following a 19.1% increase over the next decade. The prevalence of DO in the general population across the US, France, Germany, Italy, Spain, and the UK currently ranges from between 2% and 12%.

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