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Samples were submitted from across the United States and subjected to multiplex real\u2010time polymerase chain reactions for dermatophyte detection, with further screening of <jats:italic>SQLE<\/jats:italic> mutations at four known hotspots (393<jats:sup>Leu<\/jats:sup>, 397<jats:sup>Phe<\/jats:sup>, 415<jats:sup>Phe<\/jats:sup> and 440<jats:sup>His<\/jats:sup>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 62,056 samples were submitted (mean age: 57.5\u2009years; female: 60.4%). Dermatophytes were detected in 38.5% of samples, primarily <jats:italic>Trichophyton rubrum<\/jats:italic> complex (83.6%) and <jats:italic>T. mentagrophytes<\/jats:italic> complex (10.7%). A survey of <jats:italic>SQLE<\/jats:italic> mutations was carried out in 22,610 dermatophyte samples; there was a significant increase in the prevalence of <jats:italic>SQLE<\/jats:italic> mutations between the first quarter of 2022 and the second quarter of 2023 (29.0 to 61.9 per 1000 persons). The Phe397Leu substitution was the predominant mutation; Phe415Ser and His440Tyr have also emerged which were previously reported as minor mutations in skin samples. The temporal change in mutation rates can be primarily attributed to the Phe415Ser substitution. Samples from elderly patients (&gt;70\u2009years) are more likely to be infected with the <jats:italic>T.\u00a0mentagrophytes<\/jats:italic> complex including strains harbouring the Phe415Ser substitution.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The prevalence of <jats:italic>SQLE<\/jats:italic> mutations among onychomycosis patients with <jats:italic>Trichophyton<\/jats:italic> infections may be underestimated. Older individuals may have a higher risk.<\/jats:p><\/jats:sec>","DOI":"10.1111\/myc.13768","type":"journal-article","created":{"date-parts":[[2024,7,22]],"date-time":"2024-07-22T10:41:30Z","timestamp":1721644890000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Potential emergence of terbinafine resistance by squalene epoxidase gene mutations: An 18\u2010month cohort study of onychomycosis patients in the United States"],"prefix":"10.1111","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8664-7723","authenticated-orcid":false,"given":"Aditya K.","family":"Gupta","sequence":"first","affiliation":[{"name":"Division of Dermatology, Department of Medicine University of Toronto School of Medicine  Toronto Ontario Canada"},{"name":"Mediprobe Research Inc.  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