Special Issue "Cutaneous Fungal Diseases"

A special issue of Journal of Fungi (ISSN 2309-608X).

Deadline for manuscript submissions: closed (30 June 2015).

Special Issue Editor

Guest Editor
Prof. Dr. Theodore Rosen

Baylor College of Medicine, Houston, TX 77005, USA
Website | E-Mail
Interests: dermatophyte; dermatophytosis; onychomycosis; tinea; azole or imidazole or allylamine antifungal drugs

Special Issue Information

Dear Colleagues,

As is true of bacteria, fungi are omnipresent in the environment as well as resident on the skin surface. Fungal organisms can be commensal and harmless cutaneous residents. However, they may also cause considerable morbidity and even mortality when they become pathogens of the skin, hair and nails.

This special issue of Journal of Fungi will examine the relationship between fungi and the largest body organ, the skin surface. We will review the contribution fungi make to the normal human cutaneous microbiome. By contrast, we will also review the role “normal” fungal commensals may play in human disease states. The role of human immunosuppression and immunocompromised in predisposing to fungal disease will be discussed in order to demonstrate the interplay between homeostatic factors and disease states.

We will explore some of the new diagnostic and treatment methods for chronic and recurring fungal infections, such as onychomycosis and pityriasis versicolor, as well as the clinical use of newer, potent antifungal agents for the management of life-threatening fungal diseases. Pediatric fungal diseases, such as tinea capitis, will be reviewed in depth. Zoonotic fungal disease, especially that acquired from exotic pets, will also be explored.

The skin, hair and nails are in a particularly fragile and vulnerable position with regards to fungi. The delicate balance between health and disease due to fungi, be they dermatophytes, saprophytes or yeast, will be amply displayed in this special issue of Journal of Fungi. The editors hope you will enjoy this in-depth look at cutaneous fungi in both health and disease.

Prof. Dr. Theodore Rosen
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Fungi is an international peer-reviewed open access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1000 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.


Keywords

  • cutaneous fungi
  • saprophytes
  • dermatophytes
  • endemic mycoses
  • normal human cutaneous fungal microbiome
  • onychomycosis
  • pityriasis versicolor
  • zoonotic fungal disease
  • antifungal systemic agents
  • antifungal topical agents
  • management of fungal diseases
  • diagnosis of fungal disease
  • laser and light devices and fungal disease
  • tinea capitis
  • pediatric fungal diseases of the skin
  • deep fungal infection
  • zygomycosis/mucormycosis

Published Papers (10 papers)

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Research

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Open AccessArticle
Effective Single Photodynamic Treatment of ex Vivo Onychomycosis Using a Multifunctional Porphyrin Photosensitizer and Green Light
J. Fungi 2015, 1(2), 138-153; https://doi.org/10.3390/jof1020138
Received: 10 June 2015 / Revised: 15 July 2015 / Accepted: 21 July 2015 / Published: 27 July 2015
Cited by 2 | PDF Full-text (2106 KB) | HTML Full-text | XML Full-text
Abstract
Onychomycosis is predominantly caused by the dermatophytes Trichophyton rubrum, Trichophyton mentagrophytes and Trichophyton tonsurans. The main treatment obstacle concerns low nail-plate drug permeability. In vitro antifungal photodynamic treatment (PDT) and nail penetration enhancing effectiveness have been proven for multifunctional photosensitizer 5,10,15-tris [...] Read more.
Onychomycosis is predominantly caused by the dermatophytes Trichophyton rubrum, Trichophyton mentagrophytes and Trichophyton tonsurans. The main treatment obstacle concerns low nail-plate drug permeability. In vitro antifungal photodynamic treatment (PDT) and nail penetration enhancing effectiveness have been proven for multifunctional photosensitizer 5,10,15-tris(4-N-methylpyridinium)-20-(4-(butyramido-methylcysteinyl)-hydroxyphenyl)-[21H,23H]-porphine trichloride (PORTHE). This study investigates single PORTHE green laser/LED PDT of varying degrees of ex vivo onychomycoses in a human nail model. T. mentagrophytes, T. rubrum, T. tonsurans onychomycoses were ex vivo induced on nail pieces at 28 °C (normal air) and 37 °C (6.4% CO2) during 3 to 35 days and PDTs applied to the 37 °C infections. All dermatophytes showed increasingly nail plate invasion at 37 °C between 7 and 35 days; arthroconidia were observed after 35 days for T. mentagrophytes and T. tonsurans. Using 81 J/cm2 (532 nm) 7-day T. mentagrophytes onychomycoses were cured (92%) with 80 µM PORTHE (pH 8) after 24 h propylene glycol (PG, 40%) pre-treatment and 35-day onychomycoses (52%–67%) with 24 h PORTHE (40–80 µM)/40% PG treatment (pH 5). 28 J/cm2 LED light (525 ± 37 nm) improved cure rates to 72%, 83% and 73% for, respectively, T. mentagrophytus, T. rubrum and T. tonsurans 35-day onychomycoses and to 100% after double PDT. Data indicate PDT relevance for onychomycosis. Full article
(This article belongs to the Special Issue Cutaneous Fungal Diseases)
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Review

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Open AccessReview
Severe Dermatophytosis and Acquired or Innate Immunodeficiency: A Review
J. Fungi 2016, 2(1), 4; https://doi.org/10.3390/jof2010004
Received: 21 October 2015 / Revised: 16 November 2015 / Accepted: 14 December 2015 / Published: 31 December 2015
Cited by 14 | PDF Full-text (1597 KB) | HTML Full-text | XML Full-text
Abstract
Dermatophytes are keratinophilic fungi responsible for benign and common forms of infection worldwide. However, they can lead to rare and severe diseases in immunocompromised patients. Severe forms include extensive and/or invasive dermatophytosis, i.e., deep dermatophytosis and Majocchi’s granuloma. They are reported in [...] Read more.
Dermatophytes are keratinophilic fungi responsible for benign and common forms of infection worldwide. However, they can lead to rare and severe diseases in immunocompromised patients. Severe forms include extensive and/or invasive dermatophytosis, i.e., deep dermatophytosis and Majocchi’s granuloma. They are reported in immunocompromised hosts with primary (autosomal recessive CARD9 deficiency) or acquired (solid organ transplantation, autoimmune diseases requiring immunosuppressive treatments, HIV infection) immunodeficiencies. The clinical manifestations of the infection are not specific. Lymph node and organ involvement may also occur. Diagnosis requires both mycological and histological findings. There is no consensus on treatment. Systemic antifungal agents such as terbinafine and azoles (itraconazole or posaconazole) are effective. However, long-term outcome and treatment management depend on the site and extent of the infection and the nature of the underlying immunodeficiency. Full article
(This article belongs to the Special Issue Cutaneous Fungal Diseases)
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Open AccessReview
Environmental and Genetic Factors on the Development of Onychomycosis
J. Fungi 2015, 1(2), 211-216; https://doi.org/10.3390/jof1020211
Received: 30 June 2015 / Revised: 15 August 2015 / Accepted: 19 August 2015 / Published: 31 August 2015
Cited by 4 | PDF Full-text (633 KB) | HTML Full-text | XML Full-text
Abstract
Since the early 20th century, onychomycosis originated with the onset of war, the use of occlusive footwear, and the mass migration of people by transportation in the United States. Even though onychomycosis has a high prevalence in the US, other parts of the [...] Read more.
Since the early 20th century, onychomycosis originated with the onset of war, the use of occlusive footwear, and the mass migration of people by transportation in the United States. Even though onychomycosis has a high prevalence in the US, other parts of the world including Canada, West Africa, Southeast Asia, Northern Australia, and Europe have been well documented with cases of fungal toenail infection in their environments. Trichophyton rubrum (T. rubrum) is the major dermatophyte responsible for toenail fungal infection and is typically diagnosed in conjunction with tinea pedis, especially in individuals older than 60 years. Gender roles, age, cultural habits, shoe gear, sports activities, and genetic predisposition all contribute to the different presentation of onychomycosis in these areas where organisms like dermatophytes, candida, and molds were isolated in a variety of cases. Despite the differences in isolated pathogens, treatment outcomes remained consistent. This literature review discusses the influence of tinea pedis, genetics, shoe gear, sports, and age on the development of onychomycosis. Full article
(This article belongs to the Special Issue Cutaneous Fungal Diseases)
Open AccessReview
The Dermatologist’s Approach to Onychomycosis
J. Fungi 2015, 1(2), 173-184; https://doi.org/10.3390/jof1020173
Received: 24 June 2015 / Revised: 3 August 2015 / Accepted: 5 August 2015 / Published: 19 August 2015
Cited by 4 | PDF Full-text (675 KB) | HTML Full-text | XML Full-text
Abstract
Onychomycosis is a fungal infection of the toenails or fingernails that can involve any component of the nail unit, including the matrix, bed, and plate. It is a common disorder that may be a reservoir for infection resulting in significant medical problems. Moreover, [...] Read more.
Onychomycosis is a fungal infection of the toenails or fingernails that can involve any component of the nail unit, including the matrix, bed, and plate. It is a common disorder that may be a reservoir for infection resulting in significant medical problems. Moreover, onychomycosis can have a substantial influence on one’s quality of life. An understanding of the disorder and updated management is important for all health care professionals. Aside from reducing quality of life, sequelae of the disease may include pain and disfigurement, possibly leading to more serious physical and occupational limitations. Dermatologists, Podiatrists, and other clinicians who treat onychomycosis are now entering a new era when considering treatment options—topical modalities are proving more effective than those of the past. The once sought after concept of viable, effective, well-tolerated, and still easy-to-use monotherapy alternatives to oral therapy treatments for onychomycosis is now within reach given recent study data. In addition, these therapies may also find a role in combination and maintenance therapy; in order to treat the entire disease the practitioner needs to optimize these topical agents as sustained therapy after initial clearance to reduce recurrence or re-infection given the nature of the disease. Full article
(This article belongs to the Special Issue Cutaneous Fungal Diseases)
Open AccessReview
The Immunologic Response to Trichophyton Rubrum in Lower Extremity Fungal Infections
J. Fungi 2015, 1(2), 130-137; https://doi.org/10.3390/jof1020130
Received: 30 June 2015 / Revised: 30 June 2015 / Accepted: 13 July 2015 / Published: 17 July 2015
Cited by 1 | PDF Full-text (661 KB) | HTML Full-text | XML Full-text
Abstract
Manifestations of Trichophyton rubrum infestations, such as tinea pedis, tinea cruris, and tinea corporis, are among the most common human skin diseases seen throughout the world. About 80% of patients presenting with acute dermatophytosis respond well to topical antifungal treatment. However, the remaining [...] Read more.
Manifestations of Trichophyton rubrum infestations, such as tinea pedis, tinea cruris, and tinea corporis, are among the most common human skin diseases seen throughout the world. About 80% of patients presenting with acute dermatophytosis respond well to topical antifungal treatment. However, the remaining 20% of patients progress into a chronic state of dermatophytosis, which is resistant to antifungal treatment. Therefore, it is necessary to have a better understanding and appreciation for the diverse immune responses to Trichophyton as this is critical for the development of therapeutic strategies for those individuals who suffer from a chronic manifestation of Trichophyton rubrum (T. rubrum) infection. As a result, a comprehensive literature review was conducted to review and discuss previous studies that evaluated the human body’s defense to T. rubrum infections and to understand why and how these fungal infections invade the host defense system. Our research revealed that a cell-mediated immune response is critical in defending the body against T. rubrum. However, this organism has mechanisms that enable it to evade the immune system. Therefore, a more successful treatment for chronic T. rubrum infection would involve targeting the mechanisms of T. rubrum that diminish the immune response, while restoring the cell-mediated immune response. Full article
(This article belongs to the Special Issue Cutaneous Fungal Diseases)
Open AccessReview
Efinaconazole Topical Solution, 10%: Factors Contributing to Onychomycosis Success
J. Fungi 2015, 1(2), 107-114; https://doi.org/10.3390/jof1020107
Received: 1 June 2015 / Revised: 23 June 2015 / Accepted: 24 June 2015 / Published: 3 July 2015
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Abstract
To provide an adequate therapeutic effect against onychomycosis, it has been suggested that topical drugs should have two properties: drug permeability through the nail plate and into the nail bed, and retention of their antifungal activity in the disease-affected areas. Only recently has [...] Read more.
To provide an adequate therapeutic effect against onychomycosis, it has been suggested that topical drugs should have two properties: drug permeability through the nail plate and into the nail bed, and retention of their antifungal activity in the disease-affected areas. Only recently has the importance of other delivery routes (such as subungual) been discussed. Efinaconazole has been shown to have a more potent antifungal activity in vitro than the most commonly used onychomycosis treatments. The low keratin affinity of efinaconazole contributes to its effective delivery through the nail plate and retention of its antifungal activity. Its unique low surface tension formulation provides good wetting properties affording drug delivery both through and under the nail. High antifungal drug concentrations have been demonstrated in the nail of onychomycosis patients, and effectiveness of efinaconazole topical solution, 10% confirmed in two large well-controlled multicenter Phase 3 clinical studies in patients with mild-to-moderate disease. Full article
(This article belongs to the Special Issue Cutaneous Fungal Diseases)
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Open AccessReview
Laser Therapy for Onychomycosis: Fact or Fiction?
J. Fungi 2015, 1(1), 44-54; https://doi.org/10.3390/jof1010044
Received: 12 January 2015 / Revised: 18 March 2015 / Accepted: 24 March 2015 / Published: 3 April 2015
Cited by 3 | PDF Full-text (369 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Onychomycosis is a common fungal infection, afflicting some 10% of the adult population in industrialized countries. Aside from cosmetic concerns, onychomycosis can be the cause of toe and foot pain, as well as the underlying etiology for serious secondary bacterial infections and traumatic [...] Read more.
Onychomycosis is a common fungal infection, afflicting some 10% of the adult population in industrialized countries. Aside from cosmetic concerns, onychomycosis can be the cause of toe and foot pain, as well as the underlying etiology for serious secondary bacterial infections and traumatic ulcerations. In select populations, such as diabetics, the latter conditions may even result in loss of all or part of the lower extremity. Thus, a simple, cost-effective and safe treatment for onychomycosis is highly desirable. Although both topical and oral systemic antifungal agents are available for this purpose, they are not always effective, carry some medical risks, are associated with potentially significant drug-drug interactions, and may be unacceptable to patient and healthcare provider alike. Physical modalities, such as laser therapy, therefore appear appealing. The question is whether laser treatment is sufficiently efficacious and safe to warrant the current high cost per treatment. The readily available literature on this controversy will be reviewed herein. Full article
(This article belongs to the Special Issue Cutaneous Fungal Diseases)
Open AccessReview
Onychomycosis: A Review
J. Fungi 2015, 1(1), 30-43; https://doi.org/10.3390/jof1010030
Received: 28 February 2015 / Revised: 13 March 2015 / Accepted: 18 March 2015 / Published: 27 March 2015
Cited by 16 | PDF Full-text (1093 KB) | HTML Full-text | XML Full-text
Abstract
Onychomycosis is the most common nail infective disorder. It is caused mainly by anthropophilic dermatophytes, in particular by Trichophyton rubrum and T. mentagrophytes var. interdigitale. Yeasts, like Candida albicans and C. parapsilosis, and molds, like Aspergillus spp., represent the [...] Read more.
Onychomycosis is the most common nail infective disorder. It is caused mainly by anthropophilic dermatophytes, in particular by Trichophyton rubrum and T. mentagrophytes var. interdigitale. Yeasts, like Candida albicans and C. parapsilosis, and molds, like Aspergillus spp., represent the second cause of onychomycosis. The clinical suspect of onychomycosis should be confirmed my mycology. Onychoscopy is a new method that can help the physician, as in onychomycosis, it shows a typical fringed proximal margin. Treatment is chosen depending on the modality of nail invasion, fungus species and the number of affected nails. Oral treatments are often limited by drug interactions, while topical antifungal lacquers have less efficacy. A combination of both oral and systemic treatment is often the best choice. Full article
(This article belongs to the Special Issue Cutaneous Fungal Diseases)
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Open AccessReview
Antifungal Treatment for Pityriasis Versicolor
J. Fungi 2015, 1(1), 13-29; https://doi.org/10.3390/jof1010013
Received: 24 December 2014 / Revised: 3 March 2015 / Accepted: 4 March 2015 / Published: 12 March 2015
Cited by 8 | PDF Full-text (528 KB) | HTML Full-text | XML Full-text
Abstract
Background: Pityriasis versicolor (PV), also known as tinea versicolor, is caused by Malassezia species. This condition is one of the most common superficial fungal infections worldwide, particularly in tropical climates. PV is difficult to cure and the chances for relapse or recurrent infections [...] Read more.
Background: Pityriasis versicolor (PV), also known as tinea versicolor, is caused by Malassezia species. This condition is one of the most common superficial fungal infections worldwide, particularly in tropical climates. PV is difficult to cure and the chances for relapse or recurrent infections are high due to the presence of Malassezia in the normal skin flora. This review focuses on the clinical evidence supporting the efficacy of antifungal treatment for PV. Method: A systematic review of literature from the PubMed database was conducted up to 30 September 2014. The search criteria were “(pityriasis versicolor OR tinea versicolor) AND treatment”, with full text available and English language required. Conclusions: Topical antifungal medications are the first-line treatment for PV, including zinc pyrithione, ketoconazole, and terbinafine. In cases of severe or recalcitrant PV, the oral antifungal medications itraconazole and fluconazole may be more appropriate, with pramiconazole a possible future option. Oral terbinafine is not effective in treating PV and oral ketoconazole should no longer be prescribed. Maintenance, or prophylactic, therapy may be useful in preventing recurrent infection; however, at this time, there is limited research evaluating the efficacy of prophylactic antifungal treatment. Full article
(This article belongs to the Special Issue Cutaneous Fungal Diseases)

Other

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Open AccessCase Report
Cutaneous Protothecosis in a Patient with Chronic Lymphocytic Leukemia: A Case Report and Literature Review
J. Fungi 2015, 1(1), 4-12; https://doi.org/10.3390/jof1010004
Received: 17 November 2014 / Accepted: 31 December 2014 / Published: 14 January 2015
Cited by 3 | PDF Full-text (2849 KB) | HTML Full-text | XML Full-text
Abstract
Protothecosis is a rare infection, which has the potential to cause severe disease in patients with underlying immunosuppression. We describe a case of an elderly female with chronic lymphocytic leukemia (CLL), as well as other risk factors, who presented with pustular and erythematous [...] Read more.
Protothecosis is a rare infection, which has the potential to cause severe disease in patients with underlying immunosuppression. We describe a case of an elderly female with chronic lymphocytic leukemia (CLL), as well as other risk factors, who presented with pustular and erythematous plaques, initially presumed to be leukemia cutis. A biopsy with special stains revealed the lesions to be cutaneous protothecosis, thus presenting a most unusual concurrence of disease entities. The literature to date on this rare infection will be reviewed. Full article
(This article belongs to the Special Issue Cutaneous Fungal Diseases)
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