Onychomycoses due to fungi of the genus Candida: a literature review





Candida; Superficial infections; Onychomycosis.


Onychomycosis are superficial infections that are characterized by the destruction of the nail bed and adjacent tissues with yeast fungi as important etiological agents of these diseases. In this context, the present study aimed to conduct a literature review on the genus Candida, emphasizing the main species responsible for onychomycosis, according to their epidemiological, pathogenic, immunological, diagnostic and pharmacological treatment. The research was developed in an exploratory and qualitative way, with a database approach of scientific publications, repositories and indexers. In view of the articles, dissertations, books and theses, C. albicas, C. tropicalis and C. parapsilosis has been presented as the main species of the genus Candida from a clinical and epidemiological, for nail infections with diagnosis centered on the clinical history of the laboratory tests, and more recently, by the use of image recording. The infection and dissemination process in nails occurs when virulence factors (adhesion, biofilms, pleomorphism, toxins, hydrolytic enzymes and phenotypic variability), overlap the defensive factors (microbiota, mechanical barriers and immune system). The treatment is based on the eradication of the infecting microorganism and regression of signs and symptoms, with three main pharmacological strategies, topical treatment (amorolfilina, ciclopirox), oral treatment (itraconazole and fluconazole) and combination therapy, however resistance mechanisms have been associated with these drugs. Given the above, the information present in this research serves as an aid for the consolidation of clinical - epidemiological knowledge that focuses on onychomycosis, caused by fungi of the genus Candida, including students, health professionals, academics and all society.


Aggarwal, R., Targhotra, M., Sahoo, P. K., & Chauhan, M. K. (2020). Onychomycosis: Novel strategies for treatment. Journal of Drug Delivery Science and Technology, 101774.

Ahirwar, S., Singh, V., Sen, M., Mittal, V., & Das, A. (2018). Rise of superficial mycoses: A clinic epidemiological study among the patients attending tertiary health care centre in north India. Indian Journal of Microbiology Research, 5(3), 303-306.

Albuquerque Maranhão, F. C., Oliveira-Júnior, J. B., Dos Santos Araújo, M. A., & Silva, D. M. W. (2019). Mycoses in northeastern Brazil: epidemiology and prevalence of fungal species in 8 years of retrospective analysis in Alagoas. Brazilian Journal of Microbiology, 50(4), 969-978.

Ataídes, F. S. (2010). Isolamento, identificação e suscetibilidade in vitro de fungos causadores de onicomicose. Dissertação de mestrado em Medicina Tropical e Saúde Pública -Universidade Federal de Goiás, Goiânia, p. 71.

Barbieri, D. D. S. A. V. (2014). Variabilidade genética e produção de biofilme in vitro por Streptococcus mutans em associação com leveduras do gênero Candida. Tese de doutorado em Microbiologia, Parasitologia e Patologia - Universidade Federal do Paraná, Curitiba. 126.

Beuscher, T. L., & Kelechi, T. J. (2019). Onychomycosis: Diagnosis, Treatment, and Prevention. Journal of Wound Ostomy & Continence Nursing, 46(4), 333-335.

Brunke, S., & Hube, B. (2013). Two unlike cousins: Candida albicans and C. glabratainfection strategies. Cellular Microbiology, 15(5), 701-708

Bruyne, S., Speeckaert, R., Boelens, J., Hayette, M. P., Speeckaert, M., & Delanghe, J. (2019). Infrared spectroscopy as a novel tool to diagnose onychomycosis. British Journal of Dermatology, 180(3), 637-646.

Calderone, R. A., & Fonzi, W. A. (2001). Virulence factors of Candida albicans. Trends in microbiology, 9(7), 327-335.

Caneschi, C. A., Almeida, A. M., Martins, F. J.; Hyaric, M., Oliveira, M. M. E., Macedo, G. C., Almeida, M. V., & Raposo, N. R. B. (2017). In vitro antifungal activity of organic compounds derived from amino alcohols against onychomycosis. Brazilian Journal of Microbiology, 48(3), 476-482.

Cavalcante, A. A. (2017). Avaliação da atividade antifúngica do óleo essencial de Mentha spicata sobre cepas de Candida não albicans. Trabalho de Conclusão de Curso - Universidade Federal da Paraíba, João Pessoa, p. 44.

Davies-Strickleton, H., Cook, J., Hannam, S., Bennett, R., Gibbs, A., Edwards, D., Ridden, C., Ridden, J., & Cook, D. (2020). Assessment of the nail penetration of antifungal agents, with different physico-chemical properties. Plos one, 15(2), 1-11.

Deorukhkar, S. C., & Saini, S. (2015). Non albicans Candida species: a review of epidemiology, pathogenicity and antifungal resistance. Pravara Medical Review, 7(3), 7-15.

Deorukhkar, S. C., & Saini, S. (2016). Why Candida species have emerged as important nosocomial pathogens. International Journal of Current Microbiology and Applied Sciences, 5(1), 533-545.

Feng, X., Ling, B., Yang, X., Liao, W., Pan, W., & Yao, Z. (2015). Molecular identification of Candida species isolated from onychomycosis in Shanghai, China. Mycopathologia, 180 (5-6), 365-371.

Feng, X., Xiong, X., & Ran, Y. (2017). Efficacy and tolerability of amorolfine 5% nail lacquer in combination with systemic antifungal agents for onychomycosis: A meta analysis and systematic review. Dermatologic therapy, 30(3), 1-6.

Flores, F. C., Beck, R. C., & Da Silva, C. D. B. (2016). Essential oils for treatment for onychomycosis: a mini-review. Mycopathologia, 181(1-2), 9-15.

Flores-Gavilán, P., Toussaint-Caire, S., & Arenas, R. (2017). Onychomycosis: Role of Histopathology. In Onychomycosis, 123-129. Springer, Cham: Elsevier.

Freedman, J. B., & Tosti, A. (2017). Distal Subungual Onychomycosis. In Onychomycosis, 21-34. Springer, Cham: Elsevier.

Ginter-Hanselmayer, G., & Nenoff, P. (2019). Clinically Relevant Mycoses Dermatomycoses. In Clinically Relevant Mycoses (pp. 145-176). Springer, Cham: Elsevier.

Glinos, G., & Tosti, A. (2017). Proximal Subungual Onychomycosis. In Onychomycosis (pp. 45-55). Springer, Cham: Elsevier.

Gorthi, L. V. (2019). Morphological Classification of Fungal Infections (Yeasts, Mold, Dimorphic). In Fungal Infections of the Central Nervous System (pp. 23-30). Springer, Cham: Elsevier.

Gupta, A. K., & Foley, K. A. (2018). Evidence for biofilms in onychomycosis. Giornale italiano di dermatologia e venereologia: organoufficiale, Societa italiana di dermatologia e sifilografia, 154(1), 50-55.

Gupta, A. K., & Studholme, C. (2016). Novel investigational therapies for onychomycosis: an update. Expert opinion on investigational drugs, 25(3), 297-305.

Gupta, A. K., MacLeod, M. A., & Tosti, A. (2018). Onychomycosis: Clinical Aspects. In Scher and Daniel’s Nails (pp. 153-159). Springer, Cham: Elsevier.

Gupta, A. K., Stec, N., Summerbell, R. C., Shear, N. H., Piguet, V.; Tosti, A., & Piraccini, B. M. (2020). Onychomycosis: a review. Journal of the European Academy of Dermatology and Venereology, 1-50.

Gupta, A. K., Versteeg, S. G., & Shear, N. H. (2017). Onychomycosis in the 21st century: an update on diagnosis, epidemiology, and treatment. Journal of cutaneous medicine and surgery, 21(6), 525-539.

Gupta, C., Das, S., Ramachandran, V. G., Saha, R., Bhattacharya, S. N., Dar, S. A., & Atri, D. (2016). Possible role of trichophytin antigen in inducing impaired immunological clearance of fungus in onychomycosis. Mycopathologia, 181(3-4), 247-251.

Gupta, R. K., & Gupta, P. (2017). Opportunistic fungal infections. In Pathology of Opportunistic Infections (pp. 53-130). Springer, Cham: Elsevier

Hay, R. (2017). Superficial fungal infections. Medicine, 45(11), 707-710.

Hay, R. J. (2020). Superficial mycoses. In Hunter's Tropical Medicine and Emerging Infectious Diseases (pp. 648-652). Content Repository Only.

Jellinek, N. J. (2019). Onychomycosis: The Most Common Misdiagnosis in Nail Disease. Dermatology News, p. 11.

Lachance, M. A., & Starmer, W. T. (1998). Ecology and yeasts. In The Yeasts (pp. 21-30). Springer, Cham: Elsevier.

Leung, A. K., Lam, J. M., Leong, K. F., Hon, K. L., Barankin, B., Leung, A. A., & Wong, A. H. (2020). Onychomycosis: An Updated Review. Recent Patents on Inflammation & Allergy Drug Discovery, 14(1), 32-45.

Lionakis, M. S., & Edwards Jr, J. E. (2015). Candida Species.Part III Infectious Diseases and Their Etiologic Agents. (pp. 3087-3102). 8th ed. Philadelphia: Elsevier Saunders.

Lipner, S. R., & Scher, R. K. (2019). Onychomycosis: Clinical overview and diagnosis. Journal of the American Academy of Dermatology, 80(4), 835-851.

Lipner, S. R., Scher, R. K., & Rubin, A. I. (2018). Routine and Emerging Techniques in Onychomycosis Diagnosis. Onychomycosis: DiagnosisandEffective Management, 47-59.

Loguercio-Leite, C.; Groposo, C.; Dreschler-Santos, E. R.; Figueiredo, N. F.; Godinho, P. S. & Abrão, R. L. (2006). A particularidade de ser um fungo - I. Constituintes celulares. Revista Biotemas, 19(2), 17-27.

Mayser, P., & Gräser, Y. (2019). Superficial fungal infections. Harper's Textbook of Pediatric Dermatology, 527-559.

Mlacker, S., & Tosti, A. (2017). White superficial onychomycosis. In Onychomycosis (pp. 35-44). Springer, Cham: Elsevier.

Mohanty, P., Dash, S., Mohapatra, L., & Jain, M. (2019). Total dystrophic onychomycosis due to syncephalastrum racemosum–A rare cause and its novel treatment option. Indian Dermatology Online Journal, 10(2), 171

Nóbrega, J. E. D. (2007). Caracterização do fermento endógeno utilizado na fabricação do queijo Canastra no município de Medeiros, Minas Gerais, com ênfase em leveduras. Dissertação de mestradoem Ciência e Tecnologia de Alimentos - Universidade Federal de Viçoca. Viçosa.p. 94.

Oliveira Santos, G. C., Vasconcelos, C. C., Lopes, A. J., De Sousa Cartágenes, M. D. S., Allan Filho, K. D. B., Do Nascimento, F. R. F., Ramos, R. M., Pires, E. R. R. B., Andrade, M. S., Rocha, F. M. G., & de Andrade Monteiro, C. (2018). Candida infections and therapeutic strategies: mechanisms of action for traditional and alternative agents. Frontiers in Microbiology, 9, 1-23.

Petrokilidou, C., Gaitanis, G., Bassukas, I. D., Velegraki, A., Guevara, E., Vardaki, M. Z., & Kourkoumelis, N. (2020). Emerging Optical Techniques for the Diagnosis of Onychomycosis. Applied Sciences, 10(7), 1-11.

Piraccini, B. M., & Alessandrini, A. (2015). Onychomycosis: a review. Journal of Fungi, 1(1), 30-43.

Piraccini, B. M., & Starace, M. (2018). Nail Disorders. In Atlas of Pediatric Dermatoscopy (pp. 175-194). Springer, Cham: Elsevier.

Rigopoulos, D., Elewski, B., & Richert, B. (2018). Onychomycosis: diagnosis and effective management. John Wiley & Sons.

Rocha, L. F., Bittencourt, F. M., Hernandes, K. M., Gonçalves, S. M. B., Rodrigues, C. M. G., Bergamo, V. Z., Calil, L. N., & Mezzari, A. (2018). Epidemiological profile of cutaneous superficial mycoses in South, Brazil. Scientific Electronic Archives, 11(2), 133-137.

Sahni, K., Singh, S., & Dogra, S. (2018). Newer topical treatments in skin and nail dermatophyte infections. Indian Dermatology Online Journal, 9(3), 149–158.

Schaller, M., Sigurgeirsson, B., & Sarkany, M. (2017). Patient reported outcomes from two randomised studies comparing once weekly application of amorolfine 5% nail lacquer to other methods of topical treatment in distal and lateral subungual onychomycosis. Mycoses, 60(12), 800-807.

Shah, V. V., & Tosti, A. (2017). Endonyx Onychomycosis. In Onychomycosis (pp. 57-60). Springer, Cham: Elsevier.

Shapiro, R. S., Robbins, N., & Cowen, L. E. (2011). Regulatory circuitry governing fungal development, drug resistance, and disease. Microbiology and Molecular Biology Reviews, 75(2), 213-267.

Shemer, A., & Babaev, M. (2018). Fungal Infections (Onychomycosis, Tinea Pedis, Tinea Cruris, Tinea Capitis, Tinea Manuum, Tinea Corporis, different Candida Infections, and Pityriasis Versicolor) and Mycological Laboratory Analyses. In Gender and Dermatology (pp. 235-242). Springer, Cham: Elsevier.

Silva, A. K. F. (2014). Infecções urinárias nosocomiais causada por fungo do gênero Candida: uma revisão. Ciências Biológicas e da Saúde, 2(1), 45-57.

Silva, A. P. (2017). Novas estratégias para o diagnóstico de onicomicose e tratamento de terapia fotodinâmica. Tese de Doutorado em Física Biomolecular, Instituto de Física de São Carlos - Universidade de São Paulo, São Carlos. p. 195.

Silva, C. J. A., & Malta, D. J. N. (2016). A importância dos fungos na biotecnologia. Cadernos de Graduação - Ciências Biológicas e da Saúde, 2(3), 49-66.

Silva-Rocha, W. P., De Azevedo, M. F., & Chaves, G. M. (2017). Epidemiology and fungal species distribution of superficial mycoses in Northeast Brazil. Journal de mycologie medicale, 27(1), 57-64.

Souza, L. K. H., Fernandes, O. F. L., Passos, X. S., Costa, C. R., Lemos, J. A., & Silva, M. R. R. (2010). Epidemiological and mycological data of onychomycosis in Goiania, Brazil. Mycoses, 53(1), 68-71.

Sule, H., Kumurya, A. S., & Shema, F. B. (2019). Candidiasis Opportunistic Mycosis within Nigeria: A Review UMYU Journal of Microbiology Research. 4(1), 77-82.

Tabara, K., Szewczyk, A. E., Bienias, W., Wojciechowska, A., Pastuszka, M., Oszukowska, M., & Kaszuba, A. (2015). Amorolfine vs. ciclopirox–lacquers for the treatment of onychomycosis. Advances in Dermatology and Allergology Postȩpy Dermatologiii Alergologii, 32(1), 40.

Tamer, F., & Yuksel, M. E. (2019). Onychomycosis due to mixed infection with non-dermatophyte molds and yeasts. Our Dermatology Online, 10(3), 267-269.

Tedila, H., Assefa, A., & Haji, F. (2019). Candidiasis and opportunistic mycosis in human. Novel Research in Microbiology Journal, 3(1), 190-203.

Thomas, J., Jacobson, G. A., Narkowicz, C. K., Peterson, G. M., Burnet, H., & Sharpe, C. (2010). Toenail onychomycosis: an important global disease burden. Journal of clinical pharmacy and therapeutics, 35(5), 497-519.

Torres-Guerrero, E., & Arenas, R. (2017). Candida onychomycosis. In Onychomycosis (pp. 73-83). Springer, Cham: Elsevier.

Tosti, A., & Piraccini, B. M. (2018). Nail disorders. 6ª ed. Italia: Elsevier.

Vieira, F. M. R. D. M. (2016). Candida não albicans como patogénicos emergentes. Dissertação de mestrado em Ciências Farmacêuticas - Instituto Superior de Ciências da Saúde Egas Moniz. 421.



How to Cite

SILVA, S. L.; LIMA, M. E. de; SANTOS, R. D. T. dos; LIMA, E. de O. Onychomycoses due to fungi of the genus Candida: a literature review. Research, Society and Development, [S. l.], v. 9, n. 8, p. e560985771, 2020. DOI: 10.33448/rsd-v9i8.5771. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/5771. Acesso em: 13 jun. 2024.



Review Article