Epidemiology of onychomycosis

NewsBot · Jul 29, 2016

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Epidemiology of onychomycosis in Italy: prevalence data and risk factor identification.
Papini M, Piraccini BM, Difonzo E, Brunoro A.
Mycoses. 2015 Nov;58(11):659-64. doi: 10.1111/myc.12396

The prevalence of onychomycosis differs according to geographic area and over time and is influenced by several factors. The epidemiology of onychomycosis in Italy is still unclear. To evaluate the prevalence of onychomycosis in a representative sample of the Italian population a group of Dermatologists and General Practitioners carried out an observational survey on the patients coming to their office during a 1-month period. Any patient with skin or systemic disease giving their consent was enrolled. Demographic characteristics, comorbidities, lifestyles, history of previous mycosis, clinical aspects of onychomycosis and mycological evaluation were studied. A total of 8331 patients (56.7% female and 43.3% male) were evaluated. More than half of them were aged ≥46 years. Onychomycosis was diagnosed in 14.2% of patients. Big toe and thumb were the most frequently affected nails. Onychomycosis was moderate-severe in 74.1% of the cases. Mycological tests were positive in 81.3% of the cases. Dermatophytes were found in 76.6% of the cases, yeasts in 17.2% and moulds in 6.3%. Risk factors and/or comorbidities were present in 68.2% of the cases. This survey showed a 14% prevalence of onychomycosis in the evaluated population. The main risk factors were previous onychomycosis, diabetes, hallux valgus and use of occlusive footwear.
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NewsBot · May 19, 2018

High prevalence of superficial white onychomycosis by Trichophyton interdigitale in a Japanese nursing home with a geriatric hospital.
Watanabe S, Anzawa K, Mochizuki T.
Mycoses. 2017 Oct;60(10):634-637. doi: 10.1111/myc.12625. Epub 2017 Apr 24.

A mycological survey on feet was performed in a nursing home with a geriatric hospital to ascertain the prevalence of tinea lesions. Of 100 subjects, comprising 62 in the nursing home and 38 in the geriatric wing, 70 were diagnosed with tinea pedis, tinea unguium (onychomycosis) or both of which 54 had onychomycosis alone, nine tinea pedis alone and seven had co-existing onychomycosis and tinea pedis. The most common clinical type of onychomycosis was distal lateral subungual onychomycosis (DLSO) at 30 cases, followed by superficial white onychomycosis (SWO) at 23 cases. Fifteen strains of Trichophyton (T.) interdigitale isolated from 23 SWO patients comprised six molecular types (D2II, nine cases; C2II, two cases; four other types, one case of each), based on the non-transcribed spacer region (NTS) of the ribosomal DNA. The pathogen of three other SWO cases was identified as T. rubrum. Direct physical contact between the subjects was unlikely because they were bedridden most of the time. Nine T. interdigitale strains were isolated from a bathtub used by patients on the floor with a high incidence of SWO alone, and all nine strains were D2II type, which suggests nosocomial infection. Consequently, the hospital infection control policy committee was consulted, bathing arrangements were changed, and nursing staff were educated about onychomycosis.
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NewsBot · Oct 28, 2022

Onychomycosis in Two Populations with Different Socioeconomic Resources in an Urban Nucleus: A Cross-Sectional Study
Pilar Alfageme-García et al
J Fungi (Basel). 2022 Sep 24;8(10):1003

Onychomycosis is one of the most common foot conditions. Mixed onychomycosis and onychomycosis caused by non-dermatophyte moulds are increasing in incidence, especially in vulnerable populations, hence the importance of this study, which presents the prevalence of onychomycosis in a population of homeless people, comparing the findings with a sample of a well-resourced population. The total sample consisted of 70 participants, divided into two separate groups, a homeless population and a second group in which we included people attending a private clinic. The average age of the sample is [49.19 ± 28.81] with an age range of 18 to 78 years. In the homeless group, the most prevalent infectious agents were non-dermatophyte fungi, with a total of 48%, compared to 28% in the group housed. The most common site of infection in both groups was the nail of the first finger. We, therefore, conclude that there is a difference in the infecting agent in the homeless population and the population with homes.
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NewsBot · Apr 6, 2023

Prevalence and Associated Factors of Toenail Onychomycosis among Patients with Diabetes in Jordan
Hesham Alrauosh et al
Curr Diabetes Rev. 2023 Apr 3

Background: Toenail onychomycosis is common in patients with diabetes and it can increase the risk of secondary infections and foot complications. Despite several studies investigating the prevalence and associated factors of toenail onychomycosis from different parts of the world, there are no data from Jordan.

Objective: Todetermine the prevalence and the associated factors of toenail onychomycosis among patients with diabetes in Jordan.

Methods: A cross-sectional study was conducted on 375 patients with diabetes at the National Centre for Diabetes, Endocrinology, and Genetics in Amman, Jordan. Several socio-demographic and health-independent variables including foot self-care practices were collected. Toenail onychomycosis was assessed by a specimen culture and microscopic examinations. Descriptive and inferential statistics were used for data analysis.

Results: The prevalence of toenail onychomycosis was 57.6% (n=216). Multiple logistic regression revealed four significant associated factors; the presence of neuropathy (β=1.87, p=0.02), being an ex-smoker (β=2.69, p=0.01), being treated by both insulin and oral hypoglycemics drugs (β=1.32, p=0.03), and using antibiotics in the last year (β=1.78, p=0.02).

Conclusion: The prevalence of toenail onychomycosis among patients with diabetes in Jordan is high. Regular foot screening and podiatric care are recommended especially among patients with diabetic neuropathy, current treatment by insulin and oral hypoglycemics drugs, previous history of smoking, and previous use of antibiotics.
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NewsBot · Jul 13, 2023

Risk Factors and Treatment Trends for Onychomycosis: A Case–Control Study of Onychomycosis Patients in the All of Us Research Program
Samantha Jo Albucker et al
J. Fungi 2023, 9(7), 712; https://doi.org/10.3390/jof9070712

Introda significant: Onychomycosis is the most common nail disorder seen in clinical practice, and it may have significant impact on patient quality of life. Understanding risk factors for onychomycosis may help to devise screening and treatment guidelines for populations that are more susceptible to this infection. Using a national database, we aimed to explore associations between onychomycosis and age, sex, and underlying medical conditions, as well as to examine current onychomycosis treatment trends. Materials and Methods: We performed a nested, matched, case–control study of patients in the All of Us database aged ≥ 18 years (6 May 2018–1 January 2022). Onychomycosis cases were identified using International Classification of Diseases (ICD) and Systematized Nomenclature of Medicine (SNOMED) diagnostic codes (ICD-9 110.1, ICD-10 B35.1, SNOMED 414941008). Demographic information (i.e., age, sex, and race), treatments, and co-diagnoses for onychomycosis patients and case–controls were recorded. Wald’s test applied to multivariate logistic regression was used to calculate odds ratios and p-values between onychomycosis and co-diagnoses. Additionally, 95% confidence intervals were calculated with a proportion test. Results: We included 15,760 onychomycosis patients and 47,280 matched controls. The mean age of onychomycosis patients was 64.9 years, with 54.2% female, 52.8% Non-Hispanic White, 23.0% Black, 17.8% Hispanic, and 6.3% other, which was similar to controls. Patients with onychomycosis vs. controls were more likely to have a co-diagnosis of obesity (46.4%, OR 2.59 [2.49–2.69]), tinea pedis (21.5%, OR 10.9 [10.1–11.6]), peripheral vascular disease (PVD) (14.4%, OR 3.04 [2.86–3.24]), venous insufficiency (13.4%, OR 3.38 [3.15–3.59]), venous varices (5.6%, OR 2.71 [2.47–2.97]), diabetes mellitus (5.6%, OR 3.28 [2.98–3.61]), and human immunodeficiency virus (HIV) (3.5%, OR 1.8 [1.61–2.00]) (p < 0.05, all). The most frequently prescribed oral and topical medications were terbinafine (20.9%) and ciclopirox (12.4%), respectively. The most common therapeutic procedure performed was debridement (19.3%). Over the study period, ciclopirox prescriptions (Spearman correlation 0.182, p = 0.0361) and fluconazole prescriptions increased (Spearman correlation 0.665, p = 2.44 × 10−4), and griseofulvin (Spearman correlation −0.557, p = 0.0131) and itraconazole prescriptions decreased (Spearman correlation −0.681, p = 3.32 × 10−6). Conclusions: Our study demonstrated that age, obesity, tinea pedis, PVD, venous insufficiency, diabetes mellitus, and HIV were significant risk factors for onychomycosis. In addition, the most frequent oral and topical onychomycosis medications prescribed were terbinafine and ciclopirox, likely reflective of efficacy and cost considerations. Identifying and managing these risk factors is essential to preventing onychomycosis’ primary infections and recurrences and improving treatment efficacy.
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NewsBot · Jul 27, 2023

Onychomycosis in immunocompromised population: Phenotypic and molecular identification
Orion Sant'Anna Motter Borba
Source

Onychomycosis is common among immunosuppressed individuals. Renal transplant recipients (RTR) and lupus nephritis (LN) patients are submitted to corticosteroid and other immunosuppressive therapy; and diabetes mellitus (DM) patients are intrinsically immunocompromised.

Objectives: The aim of this study was to characterise and identify fungal infections on the nails (feet and hands) in immunocompromised patients.

Methods: The clinical material, nail scales (foot and/or hand), was collected from 47 RTR, 66 LN, 67 DM, and 78 immunocompetent individuals (control group). Phenotypic and molecular analyses were performed.

Results: A total of 258 patients were examined. There was a female predominance, except in the RTR. The average age was 52 years old. Lateral distal subungual onychomycosis (OSDL) (75.2%), mainly affecting the hallux nail, was frequent. The predominance of dermatophyte on toenails and Candida species on fingernails was statistically significant. A higher frequency of fingernail involvement in LN and DM, and for LN, the difference was significant (p = .0456). Infections by Candida spp. were more frequent in DM. Using molecular methods, 87.2% of diagnoses were confirmed, identifying fungal agents at the species level. Dermatophytes, Trichophyton rubrum and Trichophyton interdigitale and the species of Candida, C. parapsilosis and C. albicans, were the most frequent fungal agents.

Conclusions: Molecular techniques (sequencing of ITS regions of rDNA) offer greater accuracy, although there is no difference, regarding the detection. Clinical presentation and fungal species may differ somewhat from the general population. Immunosuppression did not increase fungal detection positivity.
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NewsBot · Nov 2, 2023

Risk factors for the development of tinea pedis and onychomycosis: Real-world evidence from a single-podiatry center, large-scale database in Japan
Takasuke Ogawa et al
J Dermatol. 2023 Oct 30

Dermatomycosis, including tinea pedis and onychomycosis, is frequently encountered in routine medical care in Japan. Identifying the risk factors for tinea pedis and onychomycosis development is important to encourage hospital visits by patients who may have these diseases but who are not undergoing any treatment. This approach may lead to the prevention of disease progression and the spread of infections to others. Risk factors for onychomycosis development have been reported both in and outside of Japan. However, most of the risk factors were identified based on a multicenter, questionnaire survey study and included evidence obtained from unclear or inconsistent diagnostic criteria for tinea pedis, onychomycosis, and identified risk factors. The current study analyzed the risk factors for developing tinea pedis and onychomycosis in real-world practice in Japan using a single-center, large-scale database that included the data of patients managed with consistent diagnostic criteria at the Podiatry Center of Juntendo University Hospital. A total of 2476 patients (1012 males, 1464 females) with a mean age of 63.4 years were included. Among these patients, 337 (13.6%) had tinea pedis and 346 (14.0%) had onychomycosis. A total of 259 patients (~ 75% of each patient population) had both diseases concomitantly. Multivariate logistic regression analysis adjusted for the possible risk factors of age (per 10 years), sex, diabetes, dialysis, visual impairment, ulcer history, lower-limb ischemia (LLI), and diabetic peripheral neuropathy (DPN) revealed that advanced age, male sex, diabetes, and LLI were independent risk factors for the development of tinea pedis. In addition, DPN was an independent risk factor for developing onychomycosis. We believe that these data are useful for identifying patients who are at high risk of developing tinea pedis and onychomycosis, which may result in disease prevention and suppression in real-world clinical practice in Japan.
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NewsBot · Oct 5, 2024

Epidemiology of Onychomycosis in the United States Characterized Using Molecular Methods, 2015-2024
Aditya K Gupta et al
J Fungi (Basel). 2024 Sep 5;10(9):633

Onychomycosis is a recalcitrant fungal infection of the nail unit that can lead to secondary infections and foot complications. Accurate pathogen identification by confirmatory testing is recommended to improve treatment outcomes. In this study, we reviewed the records of 710,541 patients whose nail specimens were sent to a single molecular diagnostic laboratory between 2015 and 2024. PCR testing revealed a more comprehensive spectrum of pathogens than previously reported, which was corroborated by the demonstration of fungal invasion on histopathology. Consistent with our current understanding, the T. rubrum complex (54.3%) are among the most common pathogens; however, a significant portion of mycology-confirmed diagnoses were caused by the T. mentagrophytes complex (6.5%), Aspergillus (7.0%) and Fusarium (4.5%). Females were significantly more likely to be infected with non-dermatophytes molds (NDMs; OR: 2.0), including Aspergillus (OR: 3.3) and Fusarium (OR: 2.0), and yeasts (OR: 1.5), including Candida albicans (OR: 2.0) and C. parapsilosis (OR 1.6), than males. The T. mentagrophytes complex became more prevalent with age, and conversely the T. rubrum complex became less prevalent with age. Patients aged ≥65 years also demonstrated a higher likelihood of contracting onychomycosis caused by NDMs (OR: 1.6), including Aspergillus (OR: 2.2), Acremonium (OR: 3.5), Scopulariopsis (OR: 2.9), Neoscytalidium (OR: 3.8), and yeasts (OR: 1.8), including C. albicans (OR: 1.9) and C. parapsilosis (OR: 1.7), than young adults. NDMs (e.g., Aspergillus and Fusarium) and yeasts were, overall, more likely to cause superficial onychomycosis and less likely to cause dystrophic onychomycosis than dermatophytes. With regards to subungual onychomycosis, Aspergillus, Scopulariopsis and Neoscytalidium had a similar likelihood as dermatophytes. The advent of molecular diagnostics enabling a timely and accurate pathogen identification can better inform healthcare providers of appropriate treatment selections and develop evidence-based recommendations.
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NewsBot · Oct 20, 2024

Onychomycosis in the US Pediatric Population-An Emphasis on Fusarium Onychomycosis
Aditya K Guptaet al
Pediatr Dermatol. 2024 Oct 18

Background: Onychomycosis is a common nail disease that is often difficult to treat with a high risk of recurrence.

Objective: To update our current understanding of the etiologic profile in pediatric patients with onychomycosis utilizing molecular diagnosis by polymerase chain reaction (PCR) combined with histopathologic examination.

Methods: Records of 19,770 unique pediatric patients were retrieved from a single diagnostic laboratory in the United States spanning over a 9-year period (March 2015 to April 2024). This cohort represents patients clinically suspected of onychomycosis seen by dermatologists and podiatrists. Dermatophytes, nondermatophyte molds (NDMs), and yeasts were identified by multiplex real-time PCR corroborated by the demonstration of fungal invasion on histopathology.

Results: An average of 37.0% of all patients sampled were mycology-confirmed to have onychomycosis. Most patients were between ages 11 and 16 years, and the rate of mycologically confirmed onychomycosis was significantly higher among the 6- to 8-year (47.2%) and 9- to 11-year (42.7%) age groups compared to the 0- to 5-year (33.1%), 12- to 14-year (33.2%), and 15- to 17-year (36.7%) age groups. The majority of infections were caused dermatophytes (74.7%) followed by NDMs (17.4%). The Trichophyton rubrum complex represents the dominant pathogen with higher detection rates in the 6- to 11-year-olds. Fusarium was the most commonly isolated NDM with an increasing prevalence with age.

Conclusions: Elementary school-aged children have a higher risk of contracting onychomycosis which may be attributed to the onset of hyperhidrosis at puberty, use of occlusive footwear, nail unit trauma, and walking barefoot. Fusarium onychomycosis may be more prevalent than expected, and this may merit consideration of management strategies.
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NewsBot · Oct 21, 2024

Nail Disease in a Nail Consultation at a Tertiary Referral Center: A 10-Year Retrospective Study
Aureliu Rosca; César Magalhães; Joana Matos; Diogo Teixeira; Rita Guedes
Skin Appendage Disord (2024) 10 (5): 396–401.

Introduction: The primary objective of this study was to determine the prevalence of nail diseases and its population in nail consultation. Methods: A retrospective study of clinical records between 2012 and 2022 was conducted. The 1,372 established diagnoses were categorized into nosological groups, which included physical signs, infectious diseases, dermatological diseases, systemic diseases, drug reactions, occupational disorders, congenital diseases, traumatic disorders, and tumors. Results: Overall, 1,239 records were enrolled, with 64% (n = 788) involving female patients. The median age was 50 years. In 71.5% of cases (n = 886), it was possible to establish an etiological diagnosis or a causative relationship based on physical findings, while 28% of patients (n = 347) presented nonspecific physical signs. Conclusion: Onychomycosis was the most prevalent diagnosis and revealed a descending trend over the 10-year period study.
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NewsBot · Nov 12, 2024

Nail Disease in a Nail Consultation at a Tertiary Referral Center: A 10-Year Retrospective Study
Aureliu Rosca; César Magalhães; Joana Matos; Diogo Teixeira; Rita Guedes
Skin Appendage Disord (2024) 10 (5): 396–401.

Introduction: The primary objective of this study was to determine the prevalence of nail diseases and its population in nail consultation. Methods: A retrospective study of clinical records between 2012 and 2022 was conducted. The 1,372 established diagnoses were categorized into nosological groups, which included physical signs, infectious diseases, dermatological diseases, systemic diseases, drug reactions, occupational disorders, congenital diseases, traumatic disorders, and tumors. Results: Overall, 1,239 records were enrolled, with 64% (n = 788) involving female patients. The median age was 50 years. In 71.5% of cases (n = 886), it was possible to establish an etiological diagnosis or a causative relationship based on physical findings, while 28% of patients (n = 347) presented nonspecific physical signs. Conclusion: Onychomycosis was the most prevalent diagnosis and revealed a descending trend over the 10-year period study.
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NewsBot · Nov 29, 2024

Prevalence and Risk Factors Predicting Onychomycosis in Patients with and Without Diabetes Mellitus in Spain: A Cross-Sectional Study
David Navarro-Pérez et al
J Fungi (Basel). 2024 Nov 14;10(11):790.

Background: A cross-sectional study was conducted to investigate the prevalence of onychomycosis (ONM) and its causative pathogens in populations with and without diabetes in Spain. The association between the presence of ONM, different risk factors, and comorbidities was also examined.

Methodology: A total of 160 patients with diabetes and 160 individuals without diabetes were recruited consecutively. A single investigator recorded the relative data of each patient and sampled nail dust and detritus for microbiological culture and polymerase chain reaction (PCR) analyses of patients who showed clinical signs of fungal infection.

Results: The prevalence of ONM was 36.88% (59/160) in the population with diabetes, 17.5% (28/160) in the population without diabetes, and 34.35% (45/131) in the population with diabetic foot. Dermatophyte fungi were most frequently identified, although the proportion was higher among those without diabetes than those with diabetes (19/28 and 28/59, respectively). However, the rate of mixed infections was higher in the population with diabetes compared to those without diabetes (13/59 and 2/28, respectively). A statistically significant association was found between the presence of diabetes and the risk of ONM (p < 0.001; odds ratio (OR) = 2.754; 95% confidence interval (CI) 1.652-4.679). The risk factors associated with ONM among the patients with diabetes were a history of minor amputation, revascularisation, or cardiovascular disease, a low educational level, HbA1c values > 7%, hyperkeratosis, and subungual detritus. Among the patients without diabetes, nail thickening and chromonychia were associated with ONM.

Conclusion: The results of this study suggest that the early diagnosis of ONM and knowledge of risk factors among patients with diabetes could enable the prevention of ONM, complications, and serious injuries through education for professionals and patients.
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Epidemiology of onychomycosis

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Epidemiology of onychomycosis

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