Search Results (165)

Background/Objectives: Fingernail onychomycosis differs etiologically and epidemiologically from toenail infections and is frequently complicated by colonization and mixed growth. Reliable interpretation of microscopy–culture correlations is essential for avoiding overdiagnosis and guiding therapy. This study aimed to characterize the diagnostic structure, species distribution, and antifungal susceptibility patterns of fingernail onychomycosis in a large routine-laboratory cohort, and to evaluate the performance of a five-tier operational classification integrating microscopy and semi-quantitative culture. Methods: Laboratory records from 1075 patients with clinically suspected fingernail onychomycosis (including nail and periungual samples) were analyzed retrospectively (2017–2024). Direct microscopy with calcofluor white, semi-quantitative culture, and MALDI-TOF MS identification were performed. Cases were categorized based on predefined criteria combining microscopic elements with colony quantity and purity. Species distribution, age–sex patterns, diagnostic concordance between microscopy and culture, and results of EUCAST broth microdilution testing for selected yeasts were assessed. Results: The overall proportion of mycologically positive cases was similar in women and men, although age-dependent patterns differed. Microscopic findings correlated with culture outcomes, with hyphae predicting dermatophytes, yeast cells predicting ascomycetous yeasts, and negative slides aligning with the absence of growth. Yeasts predominated (Candida parapsilosis 30.9%, C. albicans 18.5%), dermatophytes were mainly Trichophyton rubrum, and molds were uncommon. Periungual swabs showed species distributions closely matching those from nail samples and demonstrated high analytical concordance. EUCAST MICs revealed species-dependent variation, including elevated amorolfine MICs in C. parapsilosis and reduced fluconazole activity in Wickerhamomyces pararugosa. Conclusions: Fingernail onychomycosis in this cohort was predominantly yeast-associated, with predictable microscopy–culture relationships and distinct age–sex patterns. The five-tier operational framework improved classification of infection versus colonization, and is proposed as a preliminary tool requiring clinical validation, while contemporary MIC data highlighted clinically relevant interspecies differences. The absence of clinical correlation data (symptoms, severity, treatment history) remains the primary limitation, preventing definitive distinction between infection and colonization in all cases. Full article

Background: Onychomycosis is a common nail infection primarily caused by Trichophyton rubrum, posing therapeutic challenges due to poor antifungal penetration and high recurrence rates. Conventional treatments include topical and systemic antifungals, but novel approaches such as laser therapy and chemical agents like nitric acid have emerged as promising alternatives or adjuncts. However, comparative evidence regarding the clinical and mycological efficacy of these treatments remains limited. Objectives: We aimed to assess and compare the clinical and mycological efficacy of three therapeutic modalities—69% nitric acid, 1064 nm Nd:YAG laser, and their combination—in the treatment of Trichophyton rubrum onychomycosis over a 12-month follow-up period. Methods: A prospective, comparative, observational study was conducted, assigning patients with confirmed onychomycosis to one of three treatment groups: nitric acid, Nd:YAG 1064 nm laser, or combination therapy. Clinical and mycological cure rates, mean time to clinical resolution, changes in Onychomycosis Severity Index [OSI] scores, and mycological relapse rates were assessed over a 12-month follow-up. Results: All three groups demonstrated significant improvement in both clinical and mycological cure rates, with the combination therapy yielding the most favorable outcomes in terms of response speed and durability. Laser and nitric acid monotherapies were also effective, though associated with lower cure rates and longer times to resolution. The relapse rate was lowest in the combination group. Conclusions: The combination of nitric acid and Nd:YAG laser appears to be a more effective therapeutic option for Trichophyton rubrum onychomycosis, offering superior clinical and mycological outcomes compared to monotherapies, with faster resolution and lower relapse rates. These findings suggest that combination therapy may optimize the management of this challenging nail infection. Full article

Background/Objectives: Tinea capitis is traditionally a childhood infection, yet recent reports describe its emergence among older adults. In this population, hormonal changes, comorbidities, and frequent corticosteroid use may modify clinical presentation and delay diagnosis. This systematic review aimed to consolidate current evidence on Tinea capitis in individuals aged 65 years or older, focusing on epidemiologic, clinical, and mycological characteristics as well as therapeutic outcomes. Methods: Following PRISMA 2020 guidelines, a comprehensive search was conducted in the PubMed, Scopus, and SciELO databases for studies published between 1978 and February 2025. Eligible articles included case reports, case series, and clinical studies involving patients ≥65 years with confirmed Tinea capitis. Two independent reviewers screened and extracted data on demographics, comorbidities, risk factors, clinical manifestations, diagnostic methods, etiologic agents, and treatment response. Results: Sixty-three studies comprising 91 patients from 19 countries were included. Most cases originated from Spain (n = 27) and the United States (n = 12). Females accounted for 90.1% of cases. The leading comorbidities were diabetes mellitus (37.5%) and hypertension (21.9%). Topical corticosteroid use (40.7%) and pet exposure (27.8%) were frequent risk factors. Misdiagnosis occurred in 37.4% of patients, commonly as seborrheic dermatitis or erosive pustular dermatosis. The inflammatory variant predominated (65.9%), with kerion reported in 42.9%. Microsporum canis was the predominant agent (26.9%, n = 24), while Trichophyton rubrum and Trichophyton tonsurans were equally frequent (both 19.1%, n = 17). Systemic antifungal therapy achieved clinical cure in 91.2% of cases. Conclusions: Tinea capitis in the elderly is an underrecognized and often misidentified scalp infection. Awareness of its variable presentation and systematic mycological assessment are crucial to ensure timely therapy and prevent scarring alopecia. Full article

Dermatophytes can cause infections of the skin, hair and nails. This study aims to investigate the thiosemicarbazides with nitroimidazole moiety against Trichophyton spp. The activity of fourteen thiosemicarbazide derivatives was evaluated against Trichophyton spp. The minimal inhibitory concentration (MIC) and minimal fungicidal concentration (MFC) showing 50% and 90% reduction in fungal growth after 4–7 days of incubation (MFC₅₀ and MFC₉₀) were used. The 6 and 11 (MICs ≤ 125 µg/mL), followed by the 3, 5 and 7 containing a fluorophenyl group (MIC = 125 µg/mL, MFC = 125–250 µg/mL) exhibited the best activity and specifically T. mentagrophytes, respectively. Fluorine-containing derivatives (5–9) demonstrated 2–4-fold higher activity (MIC = 31.25–1000 µg/mL) against T. rubrum than T. mentagrophytes, than their chlorinated counterparts (2–4) with MIC = 62.5–500 µg/mL. The position of the fluorine atom within the phenyl ring was important, as observed for derivatives with fluorine in the meta position (3, 6), while the para position was associated with enhanced selectivity. A methoxy group in the meta position of the phenyl ring exhibited the strongest, broadest-spectrum activity. Notably, the introduction of the trifluoromethylphenyl moiety (pharmacophore) led to the disappearance of antifungal properties. Full article

Superficial fungal skin infections are common but often misdiagnosed, which may result in inappropriate treatment and the worsening of symptoms. An accurate and timely diagnosis is essential to differentiate these infections from similar conditions such as secondary syphilis, annular psoriasis, and pityriasis rosea. This single-centre prospective cohort study at the National Skin Centre, Singapore, evaluated the diagnostic agreement between direct microscopy and fungal culture. Between August and December 2022, 268 skin scrape samples were collected from 149 patients with suspected fungal infections. Microscopy identified 67 (25.0%) positives, while fungal culture detected 42 (16.7%) positives. Among the 252 samples tested with both methods, 213 (84.5%) showed concordant results (κ = 0.487, p < 0.0001), a finding that indicates moderate agreement. The most commonly cultured organisms were Trichophyton rubrum and T. mentagrophytes. Our findings suggest that both microscopy and fungal culture may be performed to prevent true-positive cases from being missed. However, in cases where cost is a concern, microscopy can be selected as an initial diagnostic tool. Should microscopy be negative in cases with high clinical suspicion for fungal infection or when empirical treatment fails, culture remains a valuable follow-up test. These findings support a stepwise diagnostic approach—using microscopy first, then followed by culture when necessary—to improve diagnostic accuracy while enabling timely treatment. Full article

Superficial fungal infections are common conditions affecting the skin, hair, and nails, primarily caused by dermatophytes, yeasts, and less frequently, molds. Humid climates, prolonged summer seasons, immunodeficiencies, diabetes and socioeconomic factors such as poor hygiene and overcrowding promote them. Children are particularly susceptible due to their immature immune systems and other contributing factors. The infections are classified based on the site involved and include, among others, scalp infections, athlete’s foot, or nail infections (onychomycosis). Scalp mycoses are primarily caused by dermatophytes of the genera Trichophyton and Microsporum, which may originate from human or animal sources. Onychomycosis is rare in young children, with Trichophyton rubrum and Trichophyton mentagrophytes being the most frequently isolated pathogens. The increasing incidence in pediatric populations is linked to atopy, immune disorders, and immunosuppressive therapies. Treatment involves topical and systemic medications, depending on the location and severity of the infection. Maintaining proper hygiene, addressing risk factors, and monitoring therapy are essential to prevent recurrence. Focusing on children, this review explores current epidemiological trends, diagnostic practices, and treatment options related to superficial fungal infections. Full article

Twenty natural products used in traditional medicine to treat dermatophytosis were evaluated for their efficacy against Trichophyton rubrum, the most frequent dermatophyte infecting humans. For this purpose, aqueous and methanolic extracts were prepared from ash, honey, and plant organs as pure (100%) or diluted (75%, 50%, 25%, 12.5%, 6.25%, 3.125%, and 1.56%) preparations. The extracts were then evaluated by incorporating them into a Sabouraud medium and seeding them with T. rubrum as a fungal culture. The results identify fourteen extracts as being able to completely inhibit T. rubrum growth through either fungistatic or fungicidal activity. The five extracts with the highest efficacy to inhibit T. rubrum growth were further analyzed for their potential to alter in vitro reconstructed human epidermis (RHE). An aqueous extract from Allium sativum produced no tissue alteration in RHE, unlike the extracts from Conyza sumatrensis, Rumex abyssinicus, or Pentas longiflora. The data suggest that preparations used in traditional medicine by rural population in South-Kivu (DR-Congo) might represent valid alternatives to fight dermatophytosis. However, they also illustrate that several preparations remain inefficient and that others may be detrimental to the epidermis. This work reveals that traditional preparations, although affordable and easily available, require an evaluation of their efficacy and safety. Full article

Background: Onychomycosis responds poorly to topical therapy, and efinaconazole (EFN) has low aqueous solubility. Methods: This study aimed to develop a 10% w/w EFN self-nanoemulsifying system (SNEDDS) with improved solubility, permeation, antifungal activity, and stability. Excipients were screened by EFN saturation solubility. An MCT oil/Solutol HS 15/Labrafil M2125 CS SNEDDS (5/75/20, w/w) was optimized via a pseudo-ternary diagram. Characterization included droplet size, PDI, and zeta potential, morphology, and drug–excipient compatibility. Solubility was measured across pH. Permeation of EFN SNEDDS vs. EFN suspension was tested by Franz diffusion cells. Antifungal activity against Trichophyton rubrum and Trichophyton mentagrophytes was assessed by paper-disc diffusion, and hyphal damage on human nails was examined by SEM. Stability was studied for six months under room, accelerated, and stress conditions. Results: The optimized SNEDDS formed sub-50 nm droplets with low polydispersity and favourable zeta potential. Solubility was maintained across pH, and cumulative permeation increased 13.6-fold versus suspension. Paper-disc assays showed larger inhibition zones at lower EFN doses. SEM on human nails revealed marked hyphal destruction. TEM confirmed spherical nanoemulsion droplets. FT-IR showed no new peaks, supporting compatibility. Particle size, PDI, zeta potential, and drug content remained stable over six months under all storage conditions. Conclusions: A 10% w/w EFN SNEDDS enhanced solubility, transungual permeation, and antifungal efficacy while maintaining robust stability, supporting its potential as an ethanol-free therapy for onychomycosis. Full article

Background/Objectives: Bullous congenital ichthyosiform erythroderma (BCIE) is an inherited keratinization disorder caused by pathogenic variants in specific genes. Here, we report a pair of half-siblings with BCIE and tinea capitis due to Trichophyton rubrum (T. rubrum) and then review the species of ichthyosis previously reported with T. rubrum infection. Methods: We performed dermatological examination, fungal culture, and genetic analysis using whole-exome sequencing (WES) and blocker displacement amplification (BDA)-based Sanger sequencing. Both patients received oral terbinafine once daily and topical bifonazole gel for tinea capitis. Results: The pair of half-siblings had exhibited generalized scaling and hyperkeratosis since birth. Both siblings subsequently developed scalp pustules and hair loss for several months. Genetic analysis identified a pathogenic variant in the keratin 10 (KRT10) gene, confirming BCIE diagnosis. Additionally, fungal culture revealed T. rubrum infection. The patients responded positively to oral terbinafine antifungal treatment. Conclusions: This case highlights the potential susceptibility of patients with BCIE to fungal infections, warranting clinical vigilance. Furthermore, it demonstrates the utility of the BDA-based mutation detection method for diagnosing BCIE, suggesting its promise for advancing personalized diagnosis and management in hereditary skin diseases. Full article

Fungal infections pose a significant yet under-recognised global health burden, affecting over one billion individuals annually and contributing to approximately 2.5 million direct deaths. The World Health Organisation (WHO) has recently reemphasised this issue through the publication of its Fungal Priority Pathogens List (FPPL) and its 2025 report evaluating current antifungal diagnostics and therapeutics. Among the most prevalent fungal pathogens is Trichophyton rubrum, an anthropophilic dermatophyte responsible for up to 70% of superficial fungal infections, including onychomycosis. The emergence of antifungal resistance further complicates management, necessitating the development of novel, effective, and sustainable treatment alternatives. Natural compounds are increasingly being explored for their antifungal potential due to their broad-spectrum activity and lower toxicity. Coconut oil has gained particular attention for its therapeutic properties attributed to medium-chain fatty acids (MCFAs), especially lauric acid. The aim of this study was to understand how innate and modified coconut oils can alter the rheological properties of Pluronic hydrogels while retaining antifungal activity for downstream application in treating fungal infections. Results identified hydrophobic interactions by FTIR and DSC between the hydrocarbon chains of the coconut triglycerides and the hydrophobic core of the Pluronic micelles, leading to gel stabilisation as identified by rheological analysis. Full article

Azole resistance in dermatophytes, particularly Trichophyton indotineae, has become a growing global concern. Current antifungal susceptibility testing protocols (EUCAST, CLSI) have limitations in reproducibility and sensitivity. This study aimed to evaluate how medium composition, incubation temperature, and spore concentration influence itraconazole susceptibility testing across various dermatophyte species. Thirty-eight clinical isolates representing Trichophyton, Microsporum, and Epidermophyton species were tested using a microplate laser nephelometry system (MLN). IC₅₀ values for itraconazole were determined in three different media (Sabouraud glucose (SG), RPMI-based (RG), and RG supplemented with casein (RGC)) at 28 °C and 34 °C. Effects of spore concentration on growth dynamics and lag phase were also analyzed. SG medium provided clear phenotypic separation between resistant and sensitive isolates. In contrast, RG and RGC showed overlapping IC₅₀ values. Lower spore concentrations revealed underlying growth differences, which were masked at higher inoculum levels. Temperature and media composition significantly affected IC₅₀ outcomes. Genotypic analysis confirmed resistance-associated Erg11B point mutations and genomic amplifications in T. indotineae, particularly in combination with Erg1 mutations, forming distinct subpopulations. SG medium combined with reduced spore concentrations offered improved differentiation of resistant versus sensitive strains. These findings support the development of more accurate susceptibility testing protocols and highlight the need to establish species-specific ECOFF values for dermatophytes. Full article

Superficial fungal infections (SFIs) remain a common dermatological issue in the pediatric population, with varying prevalence across regions and age groups. This study aimed to assess the epidemiology of SFIs among children and adolescents in northern Poland in the years 2019 to 2024. A retrospective analysis was conducted on 1237 patients under 18 years of age who underwent direct mycological examination and culture, due to suspicion of SFIs. Data were evaluated based on age, gender, infection site, fungal species identified, and place of residence. The prevalence of SFIs in the studied population was 21.4%. The most frequently isolated fungi were Microsporum canis and Trichophyton rubrum complex. Infection patterns varied by age: tinea capitis and tinea cutis glabrae predominated in younger children, while adolescents were more affected by tinea pedis and onychomycosis. A higher proportion of positive results was observed in rural patients, although more urban dwellers were tested. Species distribution also varied with gender and place of residence. No significant change in SFI prevalence or pathogen profile was observed over the study period. This study provides updated insights into the epidemiology of SFIs in Polish children, highlighting the influence of demographic and environmental factors. The findings underscore the importance of accurate diagnosis and suggest a need for further research into behavioral and socio-economic contributors to infection patterns. Full article

Toenail onychomycosis causes significant problems in public health and is more common among the elderly and immune-compromised populations. A previous culture-based survey of communal finely ground toenails from the east coast of Australia isolated 125 T. interdigitale but only one T. rubrum. This paucity of T. rubrum was surprising because it is one of the most common dermatophytes isolated worldwide. Our aim was to find out if T. rubrum was present but not cultured. DNA was extracted from ground toenails from the same samples. New specific primers were designed for the ITS region of T. rubrum that excluded T. interdigitale and vice versa. PCR with these new primers found T. rubrum as well as T. interdigitale in all ground toenail samples. This suggests that T. rubrum was present and common in the ground toenails. It was possibly missed by culture because it grows slowly and was overgrown by T. interdigitale and non-dermatophyte moulds. Alternatively, its viability may have declined earlier, during collection, treatment, or storage of the ground toenails. This has implications for studies of clinical materials, especially nails, as infection by T. rubrum (the most common dermatophyte) may be missed by culture, the main method used in pathology laboratories. Full article

Background: Trichophyton indotineae, a new emerging pathogen according to the WHO, is known to cause severe forms of tinea. Given that traditional identification methods rely on morphological characteristics, and the morphological distinctions among T. indotineae, T. mentagrophytes, and T. interdigitale are minimal, the adoption of alternative diagnostic techniques, such as RT-PCR or gene sequencing, has become critically important to prevent misidentification. The purpose of this study was firstly to analyze the local epidemiology of dermatophytes isolated and secondly to investigate the presence of T. indotineae among the isolated strains. Methods: Between January 2021 and June 2024, 1096 samples of skin adnexa were analysed. The isolated strains belonging to the genus Trichophyton were submitted to molecular identification by ITS sequencing, and T. indotineae strains were subjected to squalene epoxidase (SQLE) sequencing analysis. Results: Trichophyton rubrum and Trichophyton interdigitale appear to be the most prevalent pathogenic species. Molecular identification reveals four T. indotineae strains (4/87; 4.61%) from Asian patients, which were also characterized by gene mutations associated with terbinafine resistance. Conclusions: This study has made it clear that there is a need to implement basic mycological diagnostics with molecular methods to avoid misidentifications, ensure the correct identification, and evaluate the presence of mutations associated with antifungal drug resistance. Full article

This study aimed to assess the incidence and distribution of dermatomycetes in patients at the Medical Military Academy (MMA) with suspected superficial skin infections over a five-year period (October 2017 to October 2022) and to analyze variations in fungal infections based on factors such as gender, body part, and time, particularly influenced by the COVID-19 pandemic. A total of 3993 samples were analyzed. Collected data were statistically analyzed with two tests. A total of 1048 samples were positive for fungal infections. Over the study period, Trichophyton mentagrophytes and Trichophyton rubrum were the predominant taxa, while Microsporum canis and Candida albicans were frequently observed. Statistical analysis indicated significant annual variations for T. mentagrophytes, T. rubrum, and M. canis, with monthly differences for T. mentagrophytes in June and August and M. canis in October and December. Gender-based analysis showed that T. rubrum and T. mentagrophytes were more common in males, while M. canis, C. albicans, Candida spp., and Geotrichum candidum were more prevalent in females. Analysis by body part revealed that Trichophyton rubrum and Microsporum canis showed significant differences between surface types. These findings can help improve diagnostic, therapeutic, and preventative strategies. Full article