{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T20:10:15Z","timestamp":1781122215297,"version":"3.54.1"},"reference-count":27,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2014,4,8]],"date-time":"2014-04-08T00:00:00Z","timestamp":1396915200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acad Dermatol Venereol"],"published-print":{"date-parts":[[2014,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Opportunistic onychomycosis is defined, when a non\u2010dermatophyte mould is cultured from an abnormal nail unit in the absence of a dermatophyte. The presumption is that the mould has caused the abnormal clinical appearance of the nail unit, yet there are no data available to substantiate this claim. Reports have only identified the mould being recovered from the nail unit niche. A review of the published dermatologic literature describing toenail opportunistic onychomycosis by non\u2010dermatophyte fungi has shown toenails with onycholysis, nail bed (NB) keratosis and nail plate surface abnormalities. The appearance of these clinical changes is indistinguishable from the diagnosis of the Asymmetric Gait Nail Unit Signs (<jats:styled-content style=\"fixed-case\">AGNUS<\/jats:styled-content>). <jats:styled-content style=\"fixed-case\">AGNUS<\/jats:styled-content> is produced by the friction of the closed shoe in patients with an asymmetric gait, resulting primarily from the ubiquitous uneven flat feet. Most commonly, species of <jats:italic>Acremonium<\/jats:italic> (<jats:italic>Cephalosporium<\/jats:italic>), <jats:italic>Aspergillus<\/jats:italic>,<jats:italic> Fusarium<\/jats:italic>,<jats:italic> Scopulariopsis<\/jats:italic> and rarely species of many different fungi genera are capable of surviving and reproducing in a keratinous environment and change the clinical appearance of the involved nail unit. <jats:styled-content style=\"fixed-case\">AGNUS<\/jats:styled-content> toenails predispose to the colonization by the non\u2010dermatophyte opportunistic fungi but not by dermatophyte fungi.<\/jats:p>","DOI":"10.1111\/jdv.12458","type":"journal-article","created":{"date-parts":[[2014,4,8]],"date-time":"2014-04-08T07:22:40Z","timestamp":1396941760000},"page":"1002-1006","source":"Crossref","is-referenced-by-count":28,"title":["Opportunistic toenail onychomycosis. The fungal colonization of an available nail unit space by non\u2010dermatophytes is produced by the trauma of the closed shoe by an asymmetric gait or other trauma. A plausible theory"],"prefix":"10.1111","volume":"28","author":[{"given":"N.","family":"Zaias","sequence":"first","affiliation":[{"name":"Dermatology division Greater Miami Skin and Laser Mount Sinai Medical Center Miami Beach FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.X.","family":"Escovar","sequence":"additional","affiliation":[{"name":"Dermatology division Greater Miami Skin and Laser Mount Sinai Medical Center Miami Beach FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Rebell","sequence":"additional","affiliation":[{"name":"Dermatology division Greater Miami Skin and Laser Mount Sinai Medical Center Miami Beach FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,4,8]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"213","article-title":"The asymmetric gait toenail unit sign (AGNUS), fungus negative, produced by an asymmetric walking gait that could 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