Clinically Relevant Mycoses Dermatomycoses

  • Gabriele Ginter-HanselmayerEmail author
  • Pietro Nenoff


The term dermatomycoses comprises superficial fungal infections of the skin and their appendages like the hair follicles and the nail apparatus. These superficial mycoses may be caused by dermatophytes or yeasts and, to a less extend, by moulds. These infections are of high importance in medical disciplines not only for the dermatologist but also for physician and the paediatrician and of course for the patients affected. With regard to the treatment of these fungal infections, the costs of topical antifungals will surpass topical corticosteroids in the healthcare system.


  1. 1.
    Gruby D (1841) Memoire sur une vegetation qui constitue la vraie teigne. C R Acad Sci 13:72–75Google Scholar
  2. 2.
    Seeliger HPR (1985) The discovery of Achorion schoenleinii. Mykosen 28:161–182PubMedCrossRefGoogle Scholar
  3. 3.
    Castellani A (1910) Observations on new species of epidermophyton found in tinea cruris. Br J Dermatol 22:147–150CrossRefGoogle Scholar
  4. 4.
    Rippon JW (1985) The changing epidemiology and emerging patterns of dermatophyte species. Curr Top Med Mycol 1:208–234PubMedCrossRefGoogle Scholar
  5. 5.
    De Hoog GS, Dukik K, Monod M, Packeu A, Stubbe D, Hendrickx M, Kupsch C, Stielow B, Freeke J, Göker M, Rezaei-Matehkolaei A, Mirhendi H, Gräser Y (2017) Toward a novel multilocus phylogenetic taxonomy for the dermatophytes. Mycopathologia 182:5–31PubMedCrossRefGoogle Scholar
  6. 6.
    Nenoff P, Uhrlaß S, Schulze I, Koch D, Rahmig N, Hipler UC, Krüger C (2017) Tinea capitis and onychomycosis due to Trichophyton soudanense in siblings from Angola – successful treatment with fluconazole. Case reports in Germany and review of the literature. Hautarzt. Scholar
  7. 7.
    Uhrlaß S, Schroedl W, Mehlhorn C, Krüger C, Hubka V, Maier T, Gräser Y, Paasch U, Nenoff P (2018) Molecular epidemiology of Trichophyton quinckeanum – a zoophilic dermatophyte on the rise. J Dtsch Dermatol Ges 16(1):21–32PubMedGoogle Scholar
  8. 8.
    English M (1962) The saprophyte growth of keratinophilic fungi on keratin. Sabouraudia 2:115–130CrossRefGoogle Scholar
  9. 9.
    Dahl MV (1987) Immunological resistance to dermatophyte infection. Adv Dermatol 2:305–320PubMedGoogle Scholar
  10. 10.
    Dahl MV, Randall C (1986) Polymorphnuclear leukocytes, compliment and Trichophyton rubrum. J Invest Dermatol 86:138–141PubMedCrossRefGoogle Scholar
  11. 11.
    Swan JW, Dahl MV, Coppo PA, Hammerschmidt DE (1983) Compliment activation by Trichophyton rubrum. J Invest Dermatol 80:156–158PubMedCrossRefGoogle Scholar
  12. 12.
    Elewski BE (1998) The superficial mycoses, the dermatophytoses, and select dermatomycosies. In: Cutaneous fungal infections, Sec. Edt. Blackwell Science, Malden, p 13–20Google Scholar
  13. 13.
    Nenoff P, Krüger C, Schaller J, Ginter-Hanselmayer G, Schulte-Beerbühl R, Tietz HJ (2014) Mycology – an update. Part 2: dermatomycoses: clinical picture and diagnostics. J Dtsch Dermatol Ges 12(9):749–777PubMedGoogle Scholar
  14. 14.
    Wan SJ, Lara-Corrales I (2018) An unresponsive rash to topical steroids: tinea incognito. Arch Dis Child 103(1):3CrossRefGoogle Scholar
  15. 15.
    Seebacher C, Bouchara JP, Mignon B (2008) Updates on the epidemiology of dermatophyte infections. Mycopathologia 166:335–352PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Nenoff P, Fischer S, Schulze I, Krüger C (2017) Trichophyton rubrum syndrome and tinea incognita under immunosuppressive treatment with leflunomide and fumaric acid esters in patients with rheumatoid arthritis and psoriasis vulgaris. Akt Dermatol 43:346–353CrossRefGoogle Scholar
  17. 17.
    Masri-Fridling GD (1996) Dermatophytosis of the feet. Dermatol Clin Cutaneous Mycol 14(1):33–40CrossRefGoogle Scholar
  18. 18.
    Mayser P (2012) Mykosen im Bereich der Leistenhaut von Händen und Füßen. Haut 23:2–6Google Scholar
  19. 19.
    Ferguson L, Fuller LC (2017) Spectrum and burden of dermatophytes in children. J Infect 74(Suppl 1):S54–S60PubMedCrossRefGoogle Scholar
  20. 20.
    Chen W, Mempel M, Traidl-Hofmann C et al (2010) Gender aspects in skin diseases. JEADV 24(12):1378–1385PubMedGoogle Scholar
  21. 21.
    Zaraa I, Hawilo A, Trojjet S et al (2012) Tinea capitis in infants in their first 2 years of life: a 12-year study and a review of the literature. Dermatol Online J 18(7):16PubMedGoogle Scholar
  22. 22.
    Ginter-Hanselmayer G, Weger W, Ilkit M, Smolle J (2007) Epidemiology of tinea capitis in Europe: current state and changing patterns. Mycoses 50(Suppl 2):6–13PubMedCrossRefGoogle Scholar
  23. 23.
    Wiegand C, Mugisha P, Mulyowa GK, Elsner P, Hipler UC, Gräser Y, Uhrlaß S, Nenoff P (2016) Trichophyton violaceum – Haupterreger der Tinea capitis bei Kindern im Mbarara Regional Referral Hospital in Uganda. Hautarzt 67:712–717PubMedCrossRefGoogle Scholar
  24. 24.
    Ilkit M, Gümral R, Saracli MA, Burgut R (2011) Trichophyton tonsurans scalp carriage among wrestlers in a national competition in Turkey. Mycopathologia 172(3):215–222PubMedCrossRefGoogle Scholar
  25. 25.
    Kawachi Y, Ikegami M, Takase T, Otsuka F (2010) Chronically recurrent and disseminated tinea faciei/corporis - autoinoculation from asymptomatic tinea capitis carriage. Pediatr Dermatol 27:527–528PubMedCrossRefGoogle Scholar
  26. 26.
    Silverman RA (1998) Pediatric mycoses-Tinea capitis. In: Cutaneous fungal infections, Sec. Edt. Blackwell Science, London, p 268–270Google Scholar
  27. 27.
    Nenoff P, Süß A, Staubach P, Anemüller A, Renner R, Uhrlaß S, Krüger C, Ginter-Hanselmayer G (2017) Tinea capitis bei Flüchtlingen und Migranten. Dtsch Dermatol 65(3):199–206CrossRefGoogle Scholar
  28. 28.
    Chen X et al (2016) Systemic antifungal therapy for tinea capitis in children: an abridged cochrane review. J Am Acad Dermatol 76:368–374. Scholar
  29. 29.
    Fuller LC, Barton RC, Mohd Mustapa MF et al (2014) British Association of Dermatologists’ guidelines for the management of Tinea capitis 2014. Br J Dermatol 171:454–463PubMedCrossRefGoogle Scholar
  30. 30.
    Wollina U, Hansel G, Uhrlaß S, Krüger C, Schönlebe J, Hipler UC, Nenoff P (2017) Deep facial mycosis in a diabetic patient caused by Trichophyton verrucosum – a case report and review of the literature. Mycoses 61(3):152–158PubMedCrossRefGoogle Scholar
  31. 31.
    Ginter-Hanselmayer G, Nenoff P, Kurrat W, Propst E, Durrant-Finn U, Uhrlaß S, Weger W (2016) Tinea im Genitalbereich. Eine diagnostische und therapeutische Herausforderung. Hautarzt 67(9):689–699PubMedCrossRefGoogle Scholar
  32. 32.
    Burns T, Breathnach S, Cox N, Griffiths C (2010) Rook’s textbook of dermatology, 8th edn. Wiley-Blackwell, ChichesterCrossRefGoogle Scholar
  33. 33.
    Nenoff P, Ginter-Hanselmayer G, Tietz HJ (2012) Fungal nail infections-an update: part 2-Prevalence, epidemiology, predisposing conditions, and differential diagnosis. Hautarzt 63(19):30–38PubMedCrossRefGoogle Scholar
  34. 34.
    Ameen M, Lear JT, Madan V, Mohd Mustapa MF, Richardson M (2014) British Association of Dermatologist’s guidelines for the management of onychomycosis 2014. Br J Dermatol 171(5):937–958. Scholar
  35. 35.
    Richardson MD, Warnock DW (2012) Fungal infection: diagnosis and management, 4th edn. Wiley-Blackwell, ChichesterCrossRefGoogle Scholar
  36. 36.
    Faergemann J, Correia O, Nowicki R, Ro BI (2005) Genetic predisposition- understanding underlying mechanisms of onychomycosis. J Eur Acad Dermatol Venereol 19:17–19PubMedCrossRefGoogle Scholar
  37. 37.
    Tsentemeidou A, Vyzantiadis TA, Kyriakou A, Sotiriadis D, Patsatsi A (2017) Prevalence of onychomycosis among patients with nail psoriasis who are not receiving immunosuppressive agents: Results of a pilot study. Mycoses 60(12):830–835PubMedCrossRefGoogle Scholar
  38. 38.
    Richardson MD, Edward M (2000) Model systems for the study of dermatophytes and non-dermatophyte invasion of human keratin. In: Kushwaha RKS, Guarro J (eds) Biology of dermatophytes and other keratinophilic fungi. Revista Iberoamericana de Micologia, Bilbao, pp 115–121Google Scholar
  39. 39.
    Yazdanparast SA, Barton RC (2006) Arthroconidia production in Trichophyton rubrum and a new ex vivo model of onychomycosis. J Med Microbiol 55:1577–1581PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Seebacher C, Müller J (2011) 50 Jahre Deutschsprachige Mykologische Gesellschaft. Ein Rückblick auf die Gründungsveranstaltung am 15. Januar 1961 in Essen. Mykol Forum 1/11:6–11Google Scholar
  41. 41.
    Manz M, Scholz GH, Willgerodt H et al (2002) Autoimmun polyglandular syndrome (APS) type I and Candida onychomycosis. Eur J Dermatol 12:283–286PubMedGoogle Scholar
  42. 42.
    Gupta AK, Drummond-Main C, Cooper EA et al (2012) Systemic review of nondermatophyte mould onychomycosis: diagnosis, clinical types, epidemiology, and treatment. JAAD 66:494–502PubMedCrossRefGoogle Scholar
  43. 43.
    Hwang SM, Suh MK, Ha GY (2012) Onychomycosis due to nondermatophytic moulds. Ann Dermatol 24:175–180PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Nenoff P, Schorlemmer B, Uhrlaß S, Baunacke A, Baunacke A, Friedrichs C, Iffländer J, Syhre E, Schneider A, Krüger C, Maier T (2016) Onychocola canadensis Sigler in onychomycosis: a new dermatophyte-like mould in Germany. Hautarzt 67(9):739–749PubMedCrossRefGoogle Scholar
  45. 45.
    Hay RJ (1996) Yeast infections. In: Thiers BH, Elgart ML (eds) Dermatologic clinics-cutaneous mycology, vol 14, Issue 1. W.B. Saunders, Philadelphia, pp 113–124PubMedCrossRefGoogle Scholar
  46. 46.
    Ginter-Hanselmayer G, Weger W, Smolle J (2008) Onychomycosis: a new emerging infectious disease in childhood population and adolescents. Report on treatment experience with terbinafine and itraconazole in 36 patients. J Eur Acad Dermatol Venereol 22:470–475PubMedCrossRefGoogle Scholar
  47. 47.
    Field LA, Adams BB (2008) Tinea pedis in athletes. Int J Dermatol 47:485–492PubMedCrossRefGoogle Scholar
  48. 48.
    Al-Mutairi N, Eassa BI, DA A-R (2010) Clinical and mycological characteristics of onychomycosis in diabetic patients. Acta Dermatovenerol Croat 18:84–91PubMedGoogle Scholar
  49. 49.
    Romano C, Massai L, Asta F, Signorini AM (2001) Prevalence of dermatophytic skin and nail infections in diabetic patients. Mycoses 44:83–86PubMedCrossRefGoogle Scholar
  50. 50.
    Elewski BE (2000) Onychomycosis. Treatment, quality of life, and economic issues. Am J Clin Dermatol 1:19–26PubMedCrossRefGoogle Scholar
  51. 51.
    Szepietowski JC, Reich A (2009) Stigmatisation in onychomycosis patients: a population-based study. Mycoses 52:343–349PubMedCrossRefGoogle Scholar
  52. 52.
    Thomas J, Jacobson GA, Narkowicz CK et al (2010) Toenail onychomycosis: an important global disease burden. J Clin Pharm Ther 35:497–519PubMedCrossRefGoogle Scholar
  53. 53.
    Tan JS, Joseph WS (2004) Common fungal infections of the feet in patients with diabetes mellitus. Drugs Aging 21:101–112PubMedCrossRefGoogle Scholar
  54. 54.
    Stuttgen G, Bauer E (1982) Bioavailability, skin- and nail-penetration of topically applied antimycotics. Mykosen 25:74–80PubMedCrossRefGoogle Scholar
  55. 55.
    Hartmane I, Dervenice A, Mailland F et al (2013) Evaluation of safety profile, pharmacokinetics, and clinical benefit of an innovative terbinafine transungual solution (p-3058): a phase I study in patients with mild-to-moderate distal subungual onychomycosis. JAAD 68(Suppl. 1):AB105Google Scholar
  56. 56.
    Iorizzo M, Ilona H, Derveniece A, Mikazans I (2015) Ciclopirox 8% HPCH nail lacquer in the treatment of mild-to-moderate onychomycosis: a randomized, double-blind amorolfine controlled study using a blinded evaluator. Skin Appendage Disord 1:134–140PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Hay RJ (2001) The future of onychomycosis therapy may involve a combination of approaches. Br J Dermatol 145(Suppl. 60):S3–S8CrossRefGoogle Scholar
  58. 58.
    Dubruyne D, Coquerel A (2001) Pharmacokinetics of antifungal agents in onychomycoses. Clin Pharmacokinet 40:441–472CrossRefGoogle Scholar
  59. 59.
    Bueno JG, Martinez C, Zapata B et al (2010) In vitro activity of fluconazole, itraconazole, voriconazole and terbinafine against fungi causing onychomycosis. Clin Exp Dermatol 35:658–663PubMedCrossRefPubMedCentralGoogle Scholar
  60. 60.
    Hall M, Monka C, Krupp P, O’Sullivan D (1997) Safety of oral terbinafine: results of a postmarketing surveillance study in 25,884 patients. Arch Dermatol 133:1213–1219PubMedCrossRefGoogle Scholar
  61. 61.
    O’Sullivan DP, Needham CA, Bangs A et al (1996) Postmarketing surveillance of oral terbinafine in the U.K.: report of a large cohort study. Br J Clin Pharmacol 42:559–565PubMedCrossRefGoogle Scholar
  62. 62.
    Gupta A, Lambert J, Revuz J, Shear N (2001) Update on the safety of itraconazole pulse therapy in onychomycosis and dermatomycoses. Eur J Dermatol 11:6–10PubMedGoogle Scholar
  63. 63.
    Singal A, Khanna D (2011) Onychomycosis: diagnosis and management. Indian J Dermatol Venereol Leprol 77:659–572PubMedCrossRefGoogle Scholar
  64. 64.
    Wollina U, Nenoff P, Haroske G, Haenssle H (2016) The diagnosis and treatment of nail disorders. Dtsch Ärztebl Intern 113:509–518Google Scholar
  65. 65.
    Verma SB (2017) A closer look at the term “tinea incognito”: a factual as well as grammatical inaccuracy. Indian J Dermatol 62(2):219–220PubMedPubMedCentralCrossRefGoogle Scholar
  66. 66.
    Champion RH, Burton JL, Ebling FJG (1994) Steroid-modified tinea. In: Rook’s textbook of dermatology, 5th edn. Blackwell, OxfordGoogle Scholar
  67. 67.
    Verma S, Hay RJ (2015) Topical steroid-induced Tinea pseudoimbricata: a striking form of tinea incognito. Int J Dermatol 54(5):e192–e193PubMedCrossRefGoogle Scholar
  68. 68.
    Rebora A, Leyden JJ (1981) Napkin (diaper) dermatitis and gastrointestinal carriage of Candida albicans. Br J Dermatol 105:551–555PubMedCrossRefGoogle Scholar
  69. 69.
    Fölster-Holst R, Buchner M, Proksch E (2011) Diaper dermatitis. Hautarzt 62:699–709PubMedCrossRefGoogle Scholar
  70. 70.
    Keiichi U, Nakayasu K, Takaishi Y (1973) Kaposi sarcoma-like granuloma on diaper dermatitis. Arch Dermatol 107:605–607CrossRefGoogle Scholar
  71. 71.
    Tappeiner J, Pfleger L (1971) Granuloma gluteale infantum. Hautarzt 22:383–388PubMedGoogle Scholar
  72. 72.
    Roberts SOB (1980) Antifungal chemotherapy. Wiley, Chichester, pp 225–383Google Scholar
  73. 73.
    Odds FC (1988) Candida and candidosis. Bailliere Tindall, LondonGoogle Scholar
  74. 74.
    Mayser P, Preuss J (2012) Pityriasis versicolor-Aktuelles zu einer alten Erkrankung. Hautarzt 63:859–867PubMedCrossRefGoogle Scholar
  75. 75.
    Jo JH, Deming C, Kennedy EA, Conlan S, Polley EC, Ng WL, Segre JA, Kong HH, NISC Comparative Sequencing Program (2016) Diverse human skin fungal communities in children converge in adulthood. J Invest Dermatol 136(12):2356–2363PubMedPubMedCentralCrossRefGoogle Scholar
  76. 76.
    Nenoff P, Krüger C, Mayser P (2015) Cutaneous Malassezia infections and Malassezia associated dermatoses: an update. Hautarzt 66(6):465–484PubMedCrossRefGoogle Scholar
  77. 77.
    Prohic A, Jovovic Sadikovic T, Krupalija-Fazlic M, Kuskunovic-Vlahovljak S. Malassezi Burke RC (1961) Tinea versicolor. Susceptibility factors and experimental infections in human beings. J Invest Dermatol 36:398; Prohic A, Jovovic Sadikovic T, Krupalija-Fazlic M, Kuskunovic-Vlahovljak S. Malassezi Burke RC (2016) A species in healthy skin and in dermatological conditions. Int J Dermatol 55(5):494–504Google Scholar
  78. 78.
    Burke RC (1961) Tinea versicolor. Susceptibility factors and experimental infections in human beings. J Invest Dermatol 36:398CrossRefGoogle Scholar
  79. 79.
    Sparber F, LeibundGut-Landmann S (2017) Host responses to Malassezia spp. in the mammalian skin. Front Immunol 8:614CrossRefGoogle Scholar
  80. 80.
    Darabi K, Hostetler SG, Bechtel MA, Zirwas M (2009) The role of Malassezia in atopic dermatitis affecting the head and neck of adults. JAAD 60:125–136PubMedCrossRefGoogle Scholar
  81. 81.
    Gupta AK, Lyons DC (2014) Pityriasis versicolor: an update on pharmacological treatment option. Expert Opin Pharmacother 15(12):1707–1713PubMedCrossRefGoogle Scholar
  82. 82.
    Balevi A, Üstüner P, Kaksi SA, Özdemir M (2017) Narrow-band UV-B phototherapy: an effective and reliable treatment alternative for extensive and recurrent pityriasis versicolor. J Dermatol Treat 9:1Google Scholar
  83. 83.
    Ohst T, Kupsch C, Gräser Y (2016) Detection of common dermatophytes in clinical specimens using a simple quantitative real-time TaqMan polymerase chain reaction assay. Br J Dermatol 174(3):602–609PubMedCrossRefGoogle Scholar
  84. 84.
    Bergmans AM, van der Ent M, Klaassen A et al (2010) Evaluation of a single-tube real-time PCR for detection and identification of 11 dermatophyte species in clinical material. Clin Microbiol Infect 16(6):704–710PubMedCrossRefGoogle Scholar
  85. 85.
    Uhrlaß S, Mayser P, Schwarz R, Koch D, Krüger C, Korfmann I, Nenoff P (2017) Dermatomycoses due to Nannizzia praecox (formerly Microsporum praecox) in Germany - case reports and review of the literature. Mycopathologia 183(2):391–398PubMedCrossRefGoogle Scholar
  86. 86.
    Wiegand C, Mugisha P, Mulyowa GK, Elsner P, Hipler UC, Gräser Y, Uhrlaß S, Nenoff P (2017) Identification of the causative dermatophyte of tinea capitis in children attending Mbarara Regional Referral Hospital in Uganda by PCR-ELISA and comparison with conventional mycological diagnostic methods. Med Mycol 55(6):660–668PubMedGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Dermatology and Venereology GrazMedical University of GrazGrazAustria
  2. 2.Labor für Medizinische MikrobiologiePartnerschaft Prof. Dr. med. Pietro Nenoff & Dr. med. Constanze KrügerRötha OTGermany

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