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Infectious Disease Reports
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Challenges in the Management of Onychomycosis and Other Superficial Fungal...
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Challenges in the Management of Onychomycosis and Other Superficial Fungal Infections

A special issue of Infectious Disease Reports (ISSN 2036-7449). This special issue belongs to the section "Fungal Infections".

Deadline for manuscript submissions: 31 August 2025 | Viewed by 1857

Special Issue Editor

Prof. Dr. Aditya K. Gupta

E-Mail Website
Guest Editor
Division of Dermatology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada
Interests: onychomycosis; tinea infection; antifungal therapy; antifungal resistance; clinical diagnosis; superficial non-dermatophyte infections
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Superficial fungal infections (dermatophytosis and tineas) are incredibly common globally, affecting up to 750 million persons in 2019. These infections disproportionately affect individuals living with co-morbidities as well as those living in underserved communities. Despite seeing these patients frequently in clinical practice, there remain ongoing challenges such as the lack of confirmatory testing, which risks misdiagnosis and empirical treatment practices that increase safety concerns. With an ever-changing global landscape, there is a pressing need to update the epidemiology of superficial fungal infections to inform healthcare providers of appropriate treatment selection.

Toenail fungus—also known as onychomycosis—represents a recalcitrant infection with a high risk of relapse, often necessitating extended treatments beyond one year. Although terbinafine has remained the most frequently prescribed antifungal medication for onychomycosis and other superficial fungal infections globally, its efficacy may be waning in view of the rise in antifungal resistance (e.g., terbinafine-resistant Trichophyton rubrum) as well as non-dermatophyte molds (e.g., Aspergillus and Fusarium). Recently, there has been renewed interests in the issue of antifungal resistance concerning the spread of a new dermatophytic pathogen with epidemic potential, Trichophyton indotineae.    

We welcome the submission of your valued work. Below is a list of potential, non-exhaustive topics:

  1. Regional/global management practices: current challenges and future outlook;
  2. Emerging pathogens and epidemiology;
  3. Diagnostic methods: old and new;
  4. Treatment and prevention strategies;
  5. New perspectives in the biology of dermatophytic pathogens and host–pathogen interactions;
  6. Antifungal resistance: prevalence, mechanisms and management.

Prof. Dr. Aditya K. Gupta
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 submissions that pass pre-check are 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. Infectious Disease Reports is an international peer-reviewed open access semimonthly 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 1800 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

  • dermatophytosis
  • tinea
  • superficial fungal infection
  • onychomycosis
  • antifungal agents
  • antifungal resistance

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Published Papers (2 papers)

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9 pages, 797 KiB  
Article
Molecular Identification of Etiological Agents in Fungal and Bacterial Skin Infections: United States, 2020–2024
by Aditya K. Gupta, Tong Wang, Sara A. Lincoln, Hui-Chen Foreman and Wayne L. Bakotic
Infect. Dis. Rep. 2024, 16(6), 1075-1083; https://doi.org/10.3390/idr16060087 - 18 Nov 2024
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Abstract
Background/Objectives: Cutaneous infections of fungal and bacterial origins are common. An accurate diagnosis—especially concerning pathogens that are difficult to isolate on culture—can be achieved using molecular methods (PCR) with a short turnaround time. Methods: We reviewed records of skin specimens (superficial [...] Read more.
Background/Objectives: Cutaneous infections of fungal and bacterial origins are common. An accurate diagnosis—especially concerning pathogens that are difficult to isolate on culture—can be achieved using molecular methods (PCR) with a short turnaround time. Methods: We reviewed records of skin specimens (superficial scrapings) submitted by dermatologists across the United States with a clinically suspected dermatitis. As per physician’s order, specimens were tested for infections either fungal (N = 4262) or bacterial (N = 1707) in origin. All unique specimens (one per patient) were subjected to real-time PCR assays where cases suspected of a fungal etiology were tested for dermatophytes, Malassezia and Candida, and cases suspected of a bacterial etiology were tested for Streptococcus pyogenes, Staphylococcus aureus, and the mecA gene potentially conferring β-lactam resistance. Results: Fungal agents were detected in 32.8% (SD: 4.5) of the submitted specimens, with most attributed to dermatophytes (19.3% (SD: 4.9)), followed by Malassezia (8.7% (SD: 2.8)) and Candida (2.9% (SD: 1.0)). Dermatophyte detection was more common in the elderly (≥65 years) compared to young adults (18–44 years) (OR: 1.8 (95% CI: 1.5, 2.2)), whereas Malassezia was more commonly detected in younger age groups (12.1–13.6%) than the elderly (5.6%). Candida was more frequently observed in females while dermatophytes and Malassezia were more frequently observed in males. Approximately one quarter of the submitted skin specimens tested positive for S. aureus (23.6% (SD: 3.4)), of which 34.4% (SD: 9.8) exhibited concurrent detection of the mecA gene. An S. aureus detection was more frequently observed in males (OR: 1.5 (95% CI: 1.2, 1.9)) and in children (OR: 1.7 (95% CI: 1.2, 2.5)). Streptococcus pyogenes was rarely detected. Among specimens positive for dermatophytes, 12.0% (20/166) showed co-detection of S. aureus and mecA, which is in contrast to 6.8% (70/1023) detected in samples without a fungal co-detection and 6.2% (8/130) in samples positive for Malassezia. Conclusions: PCR testing, when available, can be valuable as a part of routine care for diagnosing patients with clinically suspected skin infections. Further studies are warranted to survey the prevalence of resistant S. aureus isolates in dermatology outpatients, in particular with regard to the association with dermatophyte infections. Full article
(This article belongs to the Special Issue Challenges in the Management of Onychomycosis and Other Superficial Fungal Infections)
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Other

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16 pages, 592 KiB  
Systematic Review
Treatment of Onychomycosis and the Drug–Drug Interactions in Patients with Diabetes Mellitus and Diabetic Foot Syndrome: A Systematic Review
by David Navarro-Pérez, Aroa Tardáguila-García, Sara García-Oreja, Francisco Javier Álvaro-Afonso, Mateo López-Moral and José Luis Lázaro-Martínez
Infect. Dis. Rep. 2025, 17(1), 4; https://doi.org/10.3390/idr17010004 - 9 Jan 2025
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Abstract
Background: This systematic review reports on treatments for onychomycosis in patients with diabetes and the drug interactions with other drugs in regard to the complicated diabetic patient profile. Methods: The recommendations in the preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist [...] Read more.
Background: This systematic review reports on treatments for onychomycosis in patients with diabetes and the drug interactions with other drugs in regard to the complicated diabetic patient profile. Methods: The recommendations in the preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist were applied and the included studies were evaluated using the Consolidated Standards of Reporting Trials (CONSORT) statement and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Searches were conducted in November 2023, using the PubMed (Medline), Scopus, Cochrane Library, and Web of Science databases; studies on antifungal treatments for onychomycosis in patients with diabetes were included. Two authors performed the study selection and data extraction, and any discrepancies between the two reviewers were resolved through discussions with a third reviewer. This review was registered in PROSPERO (CRD42023442107). Results: The systematic review included 10 studies that met the selection criteria. Mycological cures for mild to moderate onychomycosis were: Ageratina pichinchensis (8.6%), 8% ciclopirox (8.6% 24 weeks and 54.3% 48 weeks), 10% efinaconazole (56.5–58.33%), terbinafine (73–76.6%), itraconazole (88.2%), and laser therapy (43.8%). No serious adverse effects or drug interactions were observed because patients with major complications, such as peripheral vascular disease, diabetic neuropathy, liver and renal dysfunction, poorly controlled diabetes, and severe onychomycosis, were excluded. Conclusions: The antifungal treatments described in the included studies are safe for patients with well-controlled diabetes, but there are currently no studies involving patients with diabetes and multiple complications, such as diabetic foot syndrome or severe onychomycosis. Thus, further research is needed in terms of this patient profile. Full article
(This article belongs to the Special Issue Challenges in the Management of Onychomycosis and Other Superficial Fungal Infections)
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