Skip to main content

Advertisement

SpringerLink
Log in

Epidemiology of Onychomycosis in Chinese Mainland: A 30-year Retrospective Study

  • Original Article
  • Published:
Mycopathologia Aims and scope Submit manuscript

Abstract

Background

Onychomycosis was a common nail disease caused by dermatophytes, yeasts or molds. The prevalence of onychomycosis varied in different counties and it was necessary to understand the epidemiology in China.

Objectives

This study was conducted to investigate the epidemiology of onychomycosis in Chinese mainland in the past 30 years.

Methods

A 30-year systemic review was carried out by searching publications investigating the prevalence of onychomycosis in Chinese mainland from 1991 to 2020.

Results

A total of 90 articles involving more than 40,000 onychomycosis patients were enrolled in this study. The ratio of males to females was 1:1.32. Fingernail onychomycosis was found in 36.12% cases, toenail onychomycosis in 48.31%, and both fingernail and toenail onychomycosis in 15.57%. The most common clinical type of onychomycosis was distal lateral subungual onychomycosis (60.99%), followed by total dystrophic onychomycosis (18.91%), proximal subungual onychomycosis (10.19%) and superficial white onychomycosis (9.92%). Dermatophytes (60.59%) were the most frequently isolated pathogens, followed by yeasts (30.09%), molds (7.91%) and mixed infection (1.41%). The primary pathogens in dermatophytes, yeasts and molds were Trichophyton rubrum (49.93%), Candida albicans (10.99%) and Aspergillus (3.11%), respectively. Additionally, dermatophytes were more commonly affected males than females (63.69% vs. 51.57%), and mostly involved in toenail onychomycosis (75.63%). The infection of yeasts was higher in females than males (40.97% vs. 29.52%), often causing onychomycosis in fingernail than toenail (41.03% vs. 17.08%), and it was more common in warm and humid southern regions than northern area (34.07% vs. 24.41%).

Conclusion

The proportion of the causative agents changed over time, dermatophytes, especially T. rubrum had always been the predominant pathogen, followed by yeasts and molds. The distribution of fungal pathogens varied among clinical types, gender, infection sites and geography gender.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Effendy I, Lecha M, Feuilhade de Chauvin M, Di Chiacchio N, Baran R. Epidemiology and clinical classification of onychomycosis. JEADV. 2005;19(Suppl 1):8–12. https://doi.org/10.1111/j.1468-3083.2005.01281.x.

    Article  PubMed  Google Scholar 

  2. Seebacher C, Bouchara JP, Mignon B. Updates on the epidemiology of dermatophyte infections. Mycopathologia. 2008;166(5–6):335–52. https://doi.org/10.1007/s11046-008-9100-9.

    Article  PubMed  Google Scholar 

  3. Gupta AK, Stec N, Summerbell RC, Shear NH, Piguet V, Tosti A, et al. Onychomycosis: a review. J Eur Acad Dermatol Venereol. 2020;34(9):1972–90. https://doi.org/10.1111/jdv.16394.

    Article  CAS  PubMed  Google Scholar 

  4. Lipner SR, Scher RK. Onychomycosis: clinical overview and diagnosis. J Am Acad Dermatol. 2019;80(4):835–51. https://doi.org/10.1016/j.jaad.2018.03.062.

    Article  PubMed  Google Scholar 

  5. Zhou LH, Jiang YK, Li RY, Huang LP, Yip CW, Denning DW, et al. Risk-based estimate of human fungal disease Burden. China Emerg Infect Dis. 2020;26(9):2137–47. https://doi.org/10.3201/eid2609.200016.

    Article  PubMed  Google Scholar 

  6. Dubljanin E, Džamić A, Vujčić I, Grujičić S, Arsenijević VA, Mitrović S, et al. Epidemiology of onychomycosis in Serbia: a laboratory-based survey and risk factor identification. Mycoses. 2017;60(1):25–32. https://doi.org/10.1111/myc.12537.

    Article  PubMed  Google Scholar 

  7. Song G, Zhang MJ, Liu WD, Liang GZ. Changing face of epidemiology of dermatophytoses in Chinese Mainland: a 30 years nationwide retrospective study from 1991 to 2020. Mycoses. 2022;65(4):440–8. https://doi.org/10.1111/myc.13425.

    Article  PubMed  Google Scholar 

  8. Gupta AK, Versteeg SG, Shear NH. Onychomycosis in the 21st century: an update on diagnosis, epidemiology, and treatment. J Cutan Med Surg. 2017;21(6):525–39. https://doi.org/10.1177/1203475417716362.

    Article  PubMed  Google Scholar 

  9. Burzykowski T, Molenberghs G, Abeck D, Haneke E, Hay R, Katsambas A, et al. High prevalence of foot diseases in Europe: results of the Achilles project. Mycoses. 2003;46(11–12):496–505. https://doi.org/10.1046/j.0933-7407.2003.00933.x.

    Article  CAS  PubMed  Google Scholar 

  10. Sigurgeirsson B, Baran R. The prevalence of onychomycosis in the global population: a literature study. J Eur Acad Dermatol Venereol. 2014;28(11):1480–91. https://doi.org/10.1111/jdv.12323.

    Article  CAS  PubMed  Google Scholar 

  11. Ghannoum MA, Hajjeh RA, Scher R, Konnikov N, Gupta AK, Summerbell R, et al. A large-scale North American study of fungal isolates from nails: the frequency of onychomycosis, fungal distribution, and antifungal susceptibility patterns. J Am Acad Dermatol. 2000;43(4):641–8. https://doi.org/10.1067/mjd.2000.107754.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  13. Chen M, Xu Y, Hong N, Yang Y, Lei W, Du L, et al. Epidemiology of fungal infections in China. Front Med. 2018;12(1):58–75. https://doi.org/10.1007/s11684-017-0601-0.

    Article  CAS  PubMed  Google Scholar 

  14. Cai W, Lu C, Li X, Zhang J, Zhan P, Xi L, et al. Epidemiology of superficial fungal infections in Guangdong, Southern China: a retrospective study from 2004 to 2014. Mycopathologia. 2016;181(5–6):387–95. https://doi.org/10.1007/s11046-016-9986-6.

    Article  PubMed  Google Scholar 

  15. Wu SX, Guo NR, Li XF, Liao WQ, Chen M, Zhang QQ, et al. Human pathogenic fungi in China–emerging trends from ongoing national survey for 1986, 1996, and 2006. Mycopathologia. 2011;171(6):387–93. https://doi.org/10.1007/s11046-011-9398-6.

    Article  CAS  PubMed  Google Scholar 

  16. Feng X, Ling B, Yang X, Liao W, Pan W, Yao Z. Molecular Identification of Candida Species isolated from onychomycosis in Shanghai. China Mycopathologia. 2015;180(5–6):365–71. https://doi.org/10.1007/s11046-015-9927-9.

    Article  CAS  PubMed  Google Scholar 

  17. Baran R, Hay RJ, Tosti A, Haneke E. A new classification of onychomycosis. Br J Dermatol. 1998;139(4):567–71. https://doi.org/10.1046/j.1365-2133.1998.02449.x.

    Article  CAS  PubMed  Google Scholar 

  18. Faergemann J, Baran R. Epidemiology, clinical presentation and diagnosis of onychomycosis. Br J Dermatol. 2003;149(Suppl 65):1–4. https://doi.org/10.1046/j.1365-2133.149.s65.4.x.

    Article  PubMed  Google Scholar 

  19. Mügge C, Haustein UF, Nenoff P. Causative agents of onychomycosis–a retrospective study. J Dtsch Dermatol Ges. 2006;4(3):218–28. https://doi.org/10.1111/j.1610-0387.2006.05877.x.

    Article  PubMed  Google Scholar 

  20. Kemna ME, Elewski BE. A U S epidemiologic survey of superficial fungal diseases. J Am Acad Dermatol. 1996;35(4):539–42. https://doi.org/10.1016/s0190-9622(96)90675-1.

    Article  CAS  PubMed  Google Scholar 

  21. Gupta AK, Gupta G, Jain HC, Lynde CW, Foley KA, Daigle D, et al. The prevalence of unsuspected onychomycosis and its causative organisms in a multicentre Canadian sample of 30 000 patients visiting physicians’ offices. J Eur Acad Dermatol Venereol. 2016;30(9):1567–72. https://doi.org/10.1111/jdv.13677.

    Article  CAS  PubMed  Google Scholar 

  22. Sei Y. 2011 Epidemiological survey of dermatomycoses in Japan. Med Mycol J. 2015;56(4):129–35. https://doi.org/10.3314/mmj.56.J129.

    Article  Google Scholar 

  23. Romano C, Gianni C, Difonzo EM. Retrospective study of onychomycosis in Italy: 1985–2000. Mycoses. 2005;48(1):42–4. https://doi.org/10.1111/j.1439-0507.2004.01066.x.

    Article  PubMed  Google Scholar 

  24. Midgley G, Moore MK, Cook JC, Phan QG. Mycology of nail disorders. J Am Acad Dermatol. 1994;31(3 Pt 2):S68-74. https://doi.org/10.1016/s0190-9622(08)81272-8.

    Article  CAS  PubMed  Google Scholar 

  25. Sakkas H, Kittas C, Kapnisi G, Priavali E, Kallinteri A, Bassukas ID, et al. Onychomycosis in Northwestern Greece Over a 7-year period. Pathogens. 2020;9(10):851. https://doi.org/10.3390/pathogens9100851.

    Article  PubMed Central  Google Scholar 

  26. Haghani I, Shams-Ghahfarokhi M, Dalimi Asl A, Shokohi T, Hedayati MT. Molecular identification and antifungal susceptibility of clinical fungal isolates from onychomycosis (uncommon and emerging species). Mycoses. 2019;62(2):128–43. https://doi.org/10.1111/myc.12854.

    Article  CAS  PubMed  Google Scholar 

  27. Gallo L, Cinelli E, Fabbrocini G, Vastarella M. A 15-year retrospective study on the prevalence of onychomycosis in psoriatic vs non-psoriatic patients: a new European shift from dermatophytes towards yeast. Mycoses. 2019;62(8):659–64. https://doi.org/10.1111/myc.12925.

    Article  PubMed  Google Scholar 

  28. Sylla K, Tine RCK, Sow D, Lelo S, Dia M, Traoré S, et al. Epidemiological and mycological aspects of onychomycosis in Dakar (Senegal). J Fungi. 2019. https://doi.org/10.3390/jof5020035.

    Article  Google Scholar 

  29. Motamedi M, Ghasemi Z, Shidfar MR, Hosseinpour L, Khodadadi H, Zomorodian K, et al. Growing incidence of non-dermatophyte onychomycosis in Tehran, Iran. Jundishapur J Microbiol. 2016;9(8): e40543. https://doi.org/10.5812/jjm.40543.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Ellis DH, Watson AB, Marley JE, Williams TG. Non-dermatophytes in onychomycosis of the toenails. Br J Dermatol. 1997;136(4):490–3. https://doi.org/10.1111/j.1365-2133.1997.tb02128.x.

    Article  CAS  PubMed  Google Scholar 

  31. Summerbell RC, Cooper E, Bunn U, Jamieson F, Gupta AK. Onychomycosis: a critical study of techniques and criteria for confirming the etiologic significance of nondermatophytes. Med Mycol. 2005;43(1):39–59. https://doi.org/10.1080/13693780410001712043.

    Article  PubMed  Google Scholar 

  32. Kwok YK, Tay YK, Goh CL, Kamarudin A, Koh MT, Seow CS. Epidemiology and in vitro activity of antimycotics against candidal vaginal/skin/nail infections in Singapore. Int J Dermatol. 1998;37(2):145–9. https://doi.org/10.1046/j.1365-4362.1998.00038.x.

    Article  CAS  PubMed  Google Scholar 

  33. Gupta AK, Gregurek-Novak T, Konnikov N, Lynde CW, Hofstader S, Summerbell RC. Itraconazole and terbinafine treatment of some nondermatophyte molds causing onychomycosis of the toes and a review of the literature. J Cutan Med Surg. 2001;5(3):206–10. https://doi.org/10.1007/s102270000019.

    Article  CAS  PubMed  Google Scholar 

  34. Bongomin F, Batac CR, Richardson MD, Denning DW. A review of onychomycosis due to Aspergillus species. Mycopathologia. 2018;183(3):485–93. https://doi.org/10.1007/s11046-017-0222-9.

    Article  PubMed  Google Scholar 

  35. Gupta AK, Jain HC, Lynde CW, Macdonald P, Cooper EA, Summerbell RC. Prevalence and epidemiology of onychomycosis in patients visiting physicians’ offices: a multicenter canadian survey of 15,000 patients. J Am Acad Dermatol. 2000;43(2 Pt 1):244–8. https://doi.org/10.1067/mjd.2000.104794.

    Article  CAS  PubMed  Google Scholar 

  36. Shemer A, Davidovici B, Grunwald MH, Trau H, Amichai B. New criteria for the laboratory diagnosis of nondermatophyte moulds in onychomycosis. Br J Dermatol. 2009;160(1):37–9. https://doi.org/10.1111/j.1365-2133.2008.08805.x.

    Article  CAS  PubMed  Google Scholar 

  37. Gupta AK, Mays RR, Versteeg SG, Shear NH, Piguet V. Update on current approaches to diagnosis and treatment of onychomycosis. Expert Rev Anti Infect Ther. 2018;16(12):929–38. https://doi.org/10.1080/14787210.2018.1544891.

    Article  CAS  PubMed  Google Scholar 

  38. English MP. Nails and fungi. Br J Dermatol. 1976;94(6):697–701. https://doi.org/10.1111/j.1365-2133.1976.tb05171.x.

    Article  CAS  PubMed  Google Scholar 

  39. Gupta AK, Cooper EA, MacDonald P, Summerbell RC. Utility of inoculum counting (Walshe and English criteria) in clinical diagnosis of onychomycosis caused by nondermatophytic filamentous fungi. J Clin Microbiol. 2001;39(6):2115–21. https://doi.org/10.1128/jcm.39.6.2115-2121.2001.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Gupta AK, Simpson FC. Diagnosing onychomycosis. Clin Dermatol. 2013;31(5):540–3. https://doi.org/10.1016/j.clindermatol.2013.06.009.

    Article  PubMed  Google Scholar 

  41. Zhou J, Chen M, Chen H, Pan W, Liao W. Rhodotorula minuta as onychomycosis agent in a Chinese patient: first report and literature review. Mycoses. 2014;57(3):191–5. https://doi.org/10.1111/myc.12143.

    Article  CAS  PubMed  Google Scholar 

  42. Shi D, Lu G, Mei H, de Hoog GS, Zheng H, Liang G, et al. Onychomycosis due to Chaetomium globosum with yellowish black discoloration and periungual inflammation. Med Mycol Case Rep. 2016;13:12–6. https://doi.org/10.1016/j.mmcr.2016.09.001.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Zhang MJ, Liang GZ, Mei H, Song G, Liu WD. Onychomycosis caused by Pichia guilliermondii: a case report and mini-review. Med Mycol Case Rep. 2020;8(27):72–6. https://doi.org/10.1016/j.mmcr.2020.02.002.

    Article  Google Scholar 

  44. Jayatilake JA, Tilakaratne WM, Panagoda GJ. Candidal onychomycosis: a mini-review. Mycopathologia. 2009;168(4):165–73. https://doi.org/10.1007/s11046-009-9212-x.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This work was funded by National Natural Science Foundation of China (Grant No.81972949.) and Peking Union Medical College, Fundamental Research Funds for the Central Universities (Grant No.3332020060).

Funding

This work was supported by National Natural Science Foundation of China and Peking Union Medical College, Fundamental Research Funds for the Central Universities (Grant numbers 81972949 and 3332020060).

Author information

Authors and Affiliations

  1. Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, 210042, China

    Ge Song, Meijie Zhang, Weida Liu & Guanzhao Liang

  2. Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China

    Ge Song, Meijie Zhang, Weida Liu & Guanzhao Liang

  3. CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, 210042, China

    Ge Song, Meijie Zhang, Weida Liu & Guanzhao Liang

  4. Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China

    Ge Song, Meijie Zhang, Weida Liu & Guanzhao Liang

Authors
  1. Ge Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Meijie Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Weida Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guanzhao Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

GZ Liang contributed to the study conception and design. Data collection and analysis were performed by GZ Liang, G Song and MJ Zhang. The first draft of the manuscript was written by G Song and the revision of the article was done by GZ Liang and WD Liu. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Weida Liu or Guanzhao Liang.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Additional information

Handling Editor: Ruoyu Li.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 33 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Song, G., Zhang, M., Liu, W. et al. Epidemiology of Onychomycosis in Chinese Mainland: A 30-year Retrospective Study. Mycopathologia 187, 323–331 (2022). https://doi.org/10.1007/s11046-022-00647-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11046-022-00647-4

Keywords

Search

Navigation