Dermatophytosis represents a group of superficial fungal infections caused by keratinophilic fungi belonging to the genera Trichophyton, Microsporum, and Epidermophyton, which invade keratinized tissues such as the skin, hair, and nails [1]. These infections, commonly referred to as “tinea,” are among the most prevalent dermatological conditions worldwide, affecting nearly one-quarter of the global population at any given time [1,2]. The burden is particularly high in tropical and subtropical regions, where environmental conditions such as heat and humidity favor fungal growth and transmission [2].

In recent years, a changing epidemiological pattern of dermatophytosis has been observed, especially in developing countries, with increasing reports of chronic, recurrent, and treatment-resistant infections [2,3]. Contributing factors include misuse of topical corticosteroid combinations, emergence of antifungal resistance, overcrowding, and poor hygiene practices [3]. These evolving trends have transformed dermatophytosis from a simple, easily treatable infection into a more persistent and therapeutically challenging condition.

The geriatric population represents a particularly vulnerable group for dermatophytic infections. Aging is associated with immunosenescence, characterized by a gradual decline in immune competence, which predisposes elderly individuals to infections [4,5]. Additionally, age-related changes in skin physiology—such as reduced epidermal turnover, diminished lipid content, and impaired barrier function—facilitate fungal colonization and persistence [5]. These factors collectively increase both susceptibility and severity of dermatophytosis in older adults.

Comorbidities commonly present in the elderly, including diabetes mellitus, peripheral vascular disease, and malnutrition, further exacerbate the risk and complicate disease progression [6]. Moreover, polypharmacy and the use of immunosuppressive drugs such as corticosteroids contribute to altered host defenses and atypical clinical presentations [6,7]. These atypical manifestations often result in delayed diagnosis and inappropriate management, thereby increasing the likelihood of chronic infection and recurrence [7].

Clinical patterns of dermatophytosis in the elderly may differ from those seen in younger individuals. Extensive involvement, atypical morphology, and higher prevalence of onychomycosis are frequently reported in geriatric patients [8]. Nail involvement, in particular, acts as a persistent reservoir of infection, making treatment more difficult and increasing the chances of relapse [8]. Such factors highlight the need for a more tailored and comprehensive approach to management in this age group.

Treatment of dermatophytosis in geriatric patients presents unique challenges. While topical antifungal agents remain effective for localized disease, systemic therapy is often required in elderly individuals due to widespread involvement or recalcitrant infections [9]. However, systemic antifungals must be used with caution because of age-related changes in drug metabolism, potential hepatotoxicity, and significant drug–drug interactions [9,10]. Additionally, emerging resistance to commonly used antifungal agents, particularly terbinafine, has further complicated therapeutic outcomes [3,10].

Despite the growing clinical importance of dermatophytosis in the elderly, there is a lack of consolidated evidence regarding its prevalence and treatment outcomes in this population. Available studies demonstrate considerable heterogeneity in reported prevalence rates and therapeutic success, reflecting differences in geographic settings, diagnostic criteria, and treatment protocols [2,8]. Furthermore, recurrence rates and determinants of treatment failure have not been systematically synthesized in geriatric cohorts.

In view of these gaps, a comprehensive evaluation of existing literature is essential. The present systematic review and meta-analysis aims to estimate the pooled prevalence of dermatophytosis in the geriatric population and to assess treatment outcomes, including cure rates and recurrence patterns. Generating such evidence is crucial for improving clinical management strategies and reducing disease burden in this increasingly important demographic group

This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, ensuring methodological rigor and transparency in study selection, data extraction, and analysis [11].

A comprehensive literature search was performed across electronic databases including PubMed, Scopus, Embase, and the Cochrane Library from inception until December 2025. The search strategy incorporated a combination of Medical Subject Headings (MeSH) terms and free-text keywords such as “dermatophytosis,” “tinea,” “elderly,” “geriatric,” “prevalence,” and “treatment outcomes,” combined using Boolean operators (AND/OR). Reference lists of included studies and relevant reviews were also manually screened to identify additional eligible studies.

Studies were included if they met the following criteria: involved participants aged 60 years or older; reported data on prevalence and/or treatment outcomes of dermatophytosis; employed observational (cross-sectional, case-control, cohort) or interventional study designs; and were published in the English language. Studies were excluded if they were case reports, case series with small sample sizes, review articles, editorials, or did not provide separate data for the geriatric population. Articles with incomplete or non-extractable data were also excluded.

Two independent reviewers screened titles and abstracts for eligibility, followed by full-text assessment of potentially relevant articles. Discrepancies were resolved through discussion or consultation with a third reviewer to ensure consensus. Data extraction was performed using a standardized data collection form, capturing study characteristics (author, year, country), sample size, demographic details, prevalence rates, clinical types of dermatophytosis, diagnostic methods, treatment modalities, and outcomes including cure rates and recurrence.

The methodological quality of included studies was assessed using the Newcastle–Ottawa Scale (NOS) for observational studies, while randomized controlled trials were evaluated using the Cochrane Risk of Bias Tool [12]. Studies were categorized as low, moderate, or high risk of bias based on predefined criteria.

Statistical analysis was performed using a random-effects model (DerSimonian and Laird method) to account for expected heterogeneity among studies [13]. The pooled prevalence and treatment outcomes were expressed as proportions with 95% confidence intervals. Heterogeneity was assessed using the I² statistic, with values greater than 50% indicating substantial heterogeneity [13]. Subgroup analyses were conducted based on geographical region, type of dermatophytosis, and treatment modality.

Publication bias was evaluated using visual inspection of funnel plots and quantitatively assessed using Egger’s regression test, with a p-value <0.05 considered indicative of significant bias [14]. Sensitivity analyses were performed to assess the robustness of pooled estimates by excluding studies with high risk of bias.

All statistical analyses were conducted using standard meta-analysis software, and results were presented in the form of forest plots, summary tables, and descriptive synthesis where appropriate

A total of 1,245 records were identified through database searching, of which 876 remained after removal of duplicates. Following title and abstract screening, 112 articles were subjected to full-text review. Ultimately, 32 studies fulfilled the inclusion criteria and were incorporated into the meta-analysis, representing a cumulative sample of 18,742 geriatric participants.

The included studies spanned diverse geographical regions, with the majority originating from Asia, followed by Europe, Africa, and the Americas. Most studies employed cross-sectional or cohort designs, and dermatophytosis was diagnosed based on clinical features supported by microscopy and/or culture. The characteristics of the included studies are summarized below

Table 1. Characteristics of Included Studies

The pooled prevalence of dermatophytosis among the geriatric population was estimated to be 21.4% (95% CI: 17.8–25.3), with substantial heterogeneity observed across studies (I² = 78%). Higher prevalence rates were noted in studies conducted in tropical regions, particularly South Asia and Africa, compared to temperate regions. Variability in prevalence may be attributed to differences in environmental conditions, hygiene practices, and diagnostic criteria.

Clinical subtypes of dermatophytosis varied across studies, with tinea corporis emerging as the most frequently reported presentation, followed by tinea cruris and tinea pedis. Onychomycosis was also commonly observed, particularly in elderly individuals with comorbidities such as diabetes mellitus. The distribution of clinical types is summarized below.

Table 2. Distribution of Dermatophytosis Subtypes

Analysis of treatment outcomes demonstrated an overall pooled treatment success rate of 72.6% (95% CI: 66.9–78.1), with moderate heterogeneity (I² = 64%). Studies evaluating systemic antifungal therapy reported higher cure rates compared to those using topical therapy alone. Combination therapy (topical plus systemic) showed the highest efficacy across most studies.

Recurrence of infection was reported in a significant proportion of patients, with a pooled recurrence rate of 18.3% (95% CI: 14.2–22.7). Recurrence was more frequently observed in patients with underlying comorbidities such as diabetes mellitus, immunosuppressive conditions, and those receiving incomplete or inadequate treatment.

A subgroup analysis based on treatment modality further highlighted differences in therapeutic outcomes.

Table 3. Treatment Outcomes by Modality

Geographical subgroup analysis revealed that studies from tropical regions reported both higher prevalence and higher recurrence rates compared to those from temperate regions. Additionally, studies with longer follow-up durations tended to report lower treatment success rates, likely reflecting late recurrences and chronicity of infection.

Assessment of publication bias using funnel plot visualization suggested mild asymmetry; however, Egger’s test did not demonstrate statistically significant bias (p = 0.08). Sensitivity analyses excluding studies with high risk of bias did not significantly alter pooled estimates, indicating robustness of the findings.

Overall, the results demonstrate that dermatophytosis is highly prevalent in the geriatric population, with moderate treatment success and considerable recurrence, particularly in individuals with comorbid conditions and in regions with favorable climatic conditions for fungal growth

The present systematic review and meta-analysis provides a comprehensive synthesis of the prevalence and treatment outcomes of dermatophytosis in the geriatric population. The pooled prevalence of 21.4% highlights a substantial burden of superficial fungal infections among elderly individuals, reinforcing dermatophytosis as a significant yet often under-recognized public health concern in this age group. These findings are consistent with global epidemiological estimates suggesting that dermatophytosis affects approximately one-fifth to one-quarter of the population, with disproportionately higher rates in vulnerable groups such as the elderly [1,2]. Importantly, the studies included in this meta-analysis (Table 1) consistently reported a considerable burden of disease across diverse geographical settings, including India, China, Africa, Europe, and the Americas [15–46].

The relatively high prevalence observed in this analysis can be attributed to a complex interplay of host, environmental, and behavioral factors. Aging is associated with immunosenescence, characterized by diminished cell-mediated immunity, which plays a crucial role in defense against dermatophyte infections [4,5]. In addition, structural changes in aging skin—including decreased hydration, reduced lipid content, and impaired epidermal turnover—create a favorable environment for fungal colonization and persistence [5]. Evidence from multiple included studies, particularly those conducted in India and other tropical regions, demonstrated higher infection rates in elderly individuals with underlying systemic illnesses and compromised immunity [15–19,37]. These physiological alterations are often compounded by comorbidities such as diabetes mellitus and peripheral vascular disease, which further impair host defense mechanisms and contribute to increased susceptibility [6].

Geographical variation in prevalence, with higher rates observed in tropical and subtropical regions, aligns with previous studies emphasizing the role of environmental factors such as humidity, temperature, and overcrowding in facilitating fungal transmission [2,3]. Studies from South Asia and Africa reported notably higher prevalence rates compared to those from Europe and North America, reflecting climatic and socioeconomic differences [20–25,31–33]. The predominance of tinea corporis and tinea cruris observed across multiple included studies is also consistent with reports from hot and humid climates, where occlusive clothing and excessive sweating promote fungal growth [3,15,16,24]. Furthermore, studies from Europe and the United States reported a higher proportion of onychomycosis, particularly among elderly individuals with chronic comorbidities, highlighting regional variation in clinical presentation [26–30,34–36].

Treatment outcomes in this meta-analysis revealed an overall success rate of 72.6%, indicating moderate effectiveness of current therapeutic approaches. Systemic antifungal therapy demonstrated superior efficacy compared to topical treatment alone, while combination therapy yielded the highest success rates. These findings are supported by several included cohort studies that reported improved outcomes with systemic or combined regimens, particularly in cases with extensive or nail involvement [17,18,21,23,28,35,38,41]. In contrast, studies relying solely on topical therapy reported comparatively lower cure rates, especially in chronic or recurrent infections [15,19,22,27,33,39]. This is biologically plausible, as elderly patients often present with widespread, chronic, or deep-seated infections that require systemic intervention for adequate fungal eradication [9].

The recurrence rate of 18.3% observed in this study is clinically significant and reflects the chronic and relapsing nature of dermatophytosis in elderly individuals. Several studies included in the analysis identified diabetes mellitus, immunosuppression, and inadequate treatment duration as major predictors of recurrence [18,23,29,31,40,42]. In addition, poor adherence to therapy and continued exposure to environmental reservoirs were frequently cited as contributing factors [20,24,32,43]. The emergence of antifungal resistance, particularly to terbinafine, has further complicated treatment outcomes and may partially explain the suboptimal cure rates observed in recent studies, especially from the Indian subcontinent [3,16,37].

An important observation from this analysis is the variability in treatment outcomes across studies, which may be attributed to heterogeneity in study design, diagnostic methods, antifungal regimens, and follow-up duration. Studies employing culture-based confirmation and longer follow-up periods tended to report lower success rates, likely due to more accurate diagnosis and detection of late recurrences [21,28,34,41,44]. This highlights the importance of standardized diagnostic criteria and adequate follow-up in evaluating true treatment efficacy, particularly in geriatric populations.

From a clinical perspective, these findings underscore the need for a tailored approach to the management of dermatophytosis in the elderly. Such an approach should incorporate comprehensive assessment of comorbidities, rational selection of antifungal agents, monitoring for adverse drug reactions, and patient education regarding hygiene and adherence. Several included studies emphasized the importance of combination therapy and longer treatment duration in improving outcomes among elderly patients with chronic or recurrent infections [17,23,35,41,45]. Preventive strategies, including early diagnosis, avoidance of inappropriate corticosteroid use, and management of underlying risk factors, are equally critical in reducing disease burden and recurrence [3].

The strengths of this meta-analysis include a large pooled sample size, inclusion of studies from multiple geographical regions, and application of robust statistical methods. However, certain limitations must be acknowledged. High heterogeneity among included studies may limit the generalizability of pooled estimates. Variability in diagnostic criteria and reporting standards across studies could have introduced measurement bias. Additionally, the limited number of randomized controlled trials reduces the strength of evidence regarding treatment outcomes [12].

Despite these limitations, the present study provides important insights into the epidemiology and management of dermatophytosis in the geriatric population. Future research should focus on well-designed prospective studies and randomized trials to evaluate optimal treatment regimens, particularly in the context of emerging antifungal resistance. Furthermore, region-specific clinical guidelines tailored to elderly populations are warranted to improve therapeutic outcomes and reduce recurrence rates.

In conclusion, dermatophytosis represents a significant and growing challenge in the geriatric population, characterized by high prevalence, moderate treatment success, and considerable recurrence. Addressing this burden requires an integrated approach combining effective pharmacological therapy, management of comorbidities, and targeted public health interventions [46].,

Dermatophytosis is highly prevalent among the geriatric population, with moderate treatment success and a considerable risk of recurrence. Systemic and combination antifungal therapies demonstrate better outcomes than topical treatment alone, particularly in chronic or extensive disease. Effective management requires an individualized approach that addresses comorbidities, optimizes treatment adherence, and minimizes recurrence through appropriate preventive strategies

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