Updated and contextualized version of an article originally published on August 16, 2021
The article retains its original focus by presenting it through a scholarly and accessible perspective, supported by verifiable references.
Authors
- Dr. D. Iodice – Biologist
- Roberto Panzironi –Independent researcher
Note editoriali
- First publication: August 16, 2021
- Last update: April 18, 2026
- Version: 2026 narrative revision
In brief
- Cutaneous mycoses are common infections caused by dermatophytes, yeasts (e.g., Malassezia, Candida), or molds; they affect skin, nails, and mucous membranes and often require prolonged treatments.
- Environmental factors (humidity, occlusive footwear, public places) and systemic conditions (diabetes, obesity, immunosuppressive therapies) increase the risk of infection and recurrence.
- For skin mycoses, topical treatments are effective for localized forms; nail infections and extensive forms may require oral therapies evaluated by a doctor.
- Natural remedies and supplements have variable evidence: some supplements or topical products show in vitro activity but do not always confirm solid clinical efficacy.
- Prevention (targeted hygiene, drying, ventilation of footwear and fabrics) is crucial to reduce recurrence; some commercial practices are not supported by evidence and may carry risks.
Abstract: what does science say?
Cutaneous mycoses comprise a heterogeneous group of superficial infections caused by dermatophytes, yeasts of the genus Malassezia and Candida, and, less frequently, by environmental molds. The literature highlights that prevalence varies greatly by geographical area, climate, and socioeconomic conditions; foot and nail forms are among the most common. Available evidence shows that for localized skin infections, topical treatments (particularly fungicides with fungicidal action such as allylamines) are often effective, while onychomycosis responds better to systemic therapies in extensive or recalcitrant cases. The risk of recurrence is influenced by the environment (humidity, occlusive footwear, public places) and host conditions (diabetes, obesity, immunosuppression). Some complementary approaches (probiotics, essential oils) show preliminary results but do not replace validated therapies; other proposals (colloidal silver) show signs of risk and lack robust clinical demonstration. Overall, the choice between topical and systemic therapy depends on the site, extent, suspected agent, comorbidities, and therapeutic goals; methodological limitations of numerous studies (heterogeneity, short follow-ups) require cautious interpretation of results.
What it means in practice
For the reader: a correct diagnosis often comes from clinical examination; in case of doubts or recurrences, it is advisable to consult a doctor. Localized skin mycoses frequently respond to antifungal creams or lotions applied for the recommended time; stopping therapy prematurely increases the risk of relapse. Nail infections require longer treatments and, sometimes, oral medications as directed by a doctor, with evaluation of potential side effects. Practical measures — thoroughly drying skin folds, changing wet clothing, preferring breathable footwear, avoiding walking barefoot in public areas without protection — reduce the likelihood of contagion and relapse. A balanced diet and control of metabolic conditions (e.g., diabetes) can contribute to overall skin health but do not replace antifungal therapies when necessary. Avoid prolonged use of topical corticosteroids on suspicious lesions without a diagnosis; inappropriate application can mask the infection and worsen its progression. Finally, be wary of unregulated remedies: some products have documented risks or lack convincing clinical evidence, so it is advisable to discuss them with a healthcare professional.
Main clinical pictures and how to recognize them
Cutaneous mycoses present with distinct clinical pictures depending on the agent and the site. Cutaneous dermatophytoses (tinea corporis, tinea cruris, tinea pedis) typically show erythematous, desquamating, and often itchy patches; tinea pedis is particularly associated with warm-humid environments and occlusive footwear [1]. Onychomycosis causes changes in color, fragility, and thickening of the nails and often requires a longer and more complex therapeutic approach [4]. Malassezia infections, such as pityriasis versicolor, cause hypopigmented or hyperpigmented spots on the trunk and shoulders and have a high tendency to recur in warm climates [3]. Cutaneous candidiasis involves folds and mucous membranes (including vulvovaginitis): here Candida can colonize under conditions of local or systemic imbalance. Clinical diagnosis is often sufficient, but in doubtful or recurrent cases, mycological examinations (direct examination, culture, PCR) are used for confirmation and to guide therapy.
Tinea pedis (athlete's foot)
Athlete's foot is among the most common mycoses: it is associated with itching, interdigital or hyperkeratotic scaling, and an unpleasant odor. The literature indicates a strong correlation with humid environments, prolonged use of occlusive footwear, and frequenting changing rooms or swimming pools; the internal microclimate of shoes (high temperature and humidity) is a documented risk factor for the onset and persistence of the infection [1][2].
Onychomycosis
Nail mycosis is typically more persistent: the invasion can affect the matrix and nail bed, necessitating prolonged treatment; in many cases, systemic therapy achieves higher cure rates than topical agents alone, but the choice depends on the extent, agent, and clinical conditions of the patient [5][6].
Pityriasis versicolor and Malassezia
Pityriasis versicolor is caused by yeasts of the genus Malassezia that colonize sebaceous areas: the condition tends to recur in subjects exposed to heat and humidity and may require local treatments or, in extensive cases, short oral cycles; the understanding of Malassezia's role in skin physiology is evolving and suggests complex interactions with the host and local microbiota [3].
Treatments: what the evidence suggests
Recommendations derive from reviews and guidelines that distinguish between limited superficial infections and extensive or nail forms. For localized cutaneous mycoses, topical antifungals (e.g., allylamines and some azoles) are first-line and show clinical efficacy in most cases; the recommended duration varies based on the site and severity [6]. Onychomycosis, which involves a keratinous structure, responds with more difficulty to topical treatments: studies and meta-analyses indicate that some oral therapies (e.g., terbinafine) offer superior cure rates compared to topical agents alone, but require medical evaluation for use and monitoring [4][5]. Recently developed topical devices (e.g., efinaconazole, tavaborole) improve therapeutic options for some patients, but results vary and may involve local reactions; systematic reviews highlight differences between products, quality of evidence, and possible adverse effects [6].
Topical and oral therapies: advantages and limitations
Topical therapies limit systemic exposure and are suitable for localized lesions; oral therapies are more indicated for extensive onychomycosis, tinea capitis, or widespread mycoses. The choice must balance efficacy, treatment duration, risks (e.g., hepatotoxicity for some oral antifungals), and patient preferences. Recent literature emphasizes the importance of correctly applying therapy for the recommended period to reduce recurrences [4][5][6].
Complementary approaches: probiotics, essential oils, and 'natural' substances
Some studies suggest that probiotics as adjuvants may reduce recurrences of vulvovaginal candidiasis in certain contexts, but the evidence is heterogeneous and not yet definitive as a first-line therapy [7]. Essential oils (e.g., tea tree oil) show antifungal activity in vitro and some small clinical studies with conflicting results; therefore, they are not a substitute for validated therapies and can cause skin sensitization [8]. For products like colloidal silver, the literature reports potential risks and a lack of robust proven clinical efficacy: they are not recommended as routine treatment [9].
Prevention and behaviors that reduce risk
Preventive measures are based on simple environmental and personal care precautions. Thoroughly drying skin folds and interdigital spaces after bathing, avoiding keeping wet clothing or swimwear for long periods, alternating footwear, and choosing breathable materials reduce the microclimate favorable to fungi; the role of the internal environment of footwear has been documented as a risk factor for tinea pedis [2]. Avoiding walking barefoot in changing rooms or common showers, using personal slippers, not sharing towels or bathrobes, and maintaining good footwear hygiene (drying, eventual treatment with antifungal powders) limit transmission. For subjects with systemic risk factors (diabetes, obesity, immunosuppression), control of underlying conditions and timely medical consultation at the appearance of suspicious signs are essential. Nail management (correct trimming, avoiding trauma) also reduces the likelihood of onychomycosis. These actions reduce risk but do not guarantee immunity: in the presence of persistent symptoms, clinical evaluation is necessary.
Key points to remember
- Cutaneous mycoses are common but rarely life-threatening; they often require prolonged therapies and preventive measures to avoid recurrences.
- Correct clinical diagnosis and, if necessary, mycological examinations guide the most appropriate therapeutic choice.
- For localized forms, topical treatments are effective; onychomycosis and extensive forms may require oral therapies evaluated by a doctor.
- Simple prevention (drying, footwear ventilation, avoiding humid environments without protection) is central to reducing the risk of new infections.
- Unregulated remedies (some 'natural' products, colloidal silver) have limited evidence or risks; discussing them with a doctor is advisable.
Limitations of evidence
Available evidence presents several limitations: many clinical trials are heterogeneous in design, populations, and outcomes; follow-up is often short, reducing the ability to assess long-term recurrences. There are important differences between observational studies (which show associations between risk factors and disease) and causal evidence derived from controlled clinical trials. Some alternative interventions have solid in vitro demonstrations but not robust clinical evidence; other common proposals have not been evaluated with rigorous methods. Finally, the geographical variability of pathogens and the emergence of resistant strains (reported in some areas) require caution in the general interpretation of results and highlight the need for continuous updating of clinical recommendations [4][5].
Editorial conclusion
Skin mycoses are a heterogeneous group of common conditions, impacting quality of life but manageable with an adequate diagnostic-therapeutic approach. Evidence-based medicine indicates clear diagnostic and therapeutic pathways for most cases: topical therapy for limited forms, systemic therapy for more complex situations or onychomycosis, always with attention to risks and benefits. Practical preventive measures and control of systemic conditions reduce the risk of recurrence. Critical use of commercial information or unregulated remedies remains important; therapeutic and preventive decisions should be made with professional support when necessary.
Editorial note
This article was originally published in the past and updated according to scientific and informative criteria. The content is for informational purposes only and does not replace the advice of a treating physician. In case of suspicious symptoms or chronic conditions, consult a healthcare professional.
SCIENTIFIC RESEARCH
- Pappas PG, Kauffman CA, Andes D, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases. 2016;62(4):e1–e50. https://doi.org/10.1093/cid/civ933
- Sasagawa Y, et al. Internal environment of footwear is a risk factor for tinea pedis. The Journal of Dermatology. 2019;46(11):940–946. https://doi.org/10.1111/1346-8138.15060
- Giovanni S, et al. Tinea pedis — An embarrassing problem for health and beauty: A narrative review. Mycoses. 2019;62(11):143–166. https://doi.org/10.1111/myc.13340
- Xu J, Boekhout T, et al. Malassezia: A Commensal, Pathogen, and Mutualist of Human and Animal Skin. Annual Review of Microbiology. 2022;76:757–780. https://doi.org/10.1146/annurev-micro-040820-010114
- Network Meta‑analysis: Oral antifungal therapies for toenail onychomycosis. European Journal of Dermatology. 2022; DOI: 10.1080/09546634.2020.1729336. https://doi.org/10.1080/09546634.2020.1729336
- Lipner SR, Scher RK. Onychomycosis: treatment and prevention of recurrence. Journal of the American Academy of Dermatology. 2019;80(4):853–867. https://doi.org/10.1016/j.jaad.2018.05.1260
- Cochrane Review. Topical and device-based treatments for toenail onychomycosis (Review). Cochrane Database Syst Rev. 2019; CD012093. https://doi.org/10.1002/14651858.CD012093.pub2
- Carson CF, Hammer KA, Riley TV. Antifungal activity of components of Melaleuca alternifolia (tea tree) oil. Journal of Applied Microbiology. 2003;95(4):853–860. https://doi.org/10.1046/j.1365-2672.2003.02059.x
- Systematic review: The Role of Probiotics in the Treatment of Vulvovaginal Candidiasis. Cureus. 2024; doi:10.7759/cureus.64473. https://doi.org/10.7759/cureus.64473
- Saarikoski J, et al. Toxicity of colloidal silver products and their marketing claims. Toxicology Reports. 2021;8:1234–1246. https://doi.org/10.1016/j.toxrep.2020.12.021