{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:24:23Z","timestamp":1791606263946,"version":"4.3.4"},"reference-count":45,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,6,21]],"date-time":"2025-06-21T00:00:00Z","timestamp":1750464000000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Mycoses"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      Biologic agents have become a key treatment option for moderate\u2010to\u2010severe plaque psoriasis; however, the associated risk of superficial fungal infections, such as\n                      <jats:italic>Candida<\/jats:italic>\n                      and dermatophytes infections, remains unclear. This study aims to systematically assess the impact of different biologic agents on these infection risks and to compare the differences between them.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Research questions and keywords were developed based on the Population, Intervention, Control and Outcome (PICO) framework. A systematic search of PubMed, EMBASE, the Cochrane Library and Web of Science was conducted for randomised controlled trials (RCTs) published up to December 2024, using the keywords \u2018psoriasis\u2019, \u2018biologics\u2019, \u2018anti\u2010IL\u201017\u2019, \u2018anti\u2010IL\u201012\/23\u2019, \u2018anti\u2010TNF\u2019, \u2018superficial fungal infections\u2019, \u2018dermatophyte infections\u2019, \u2018\n                      <jats:italic>Candida<\/jats:italic>\n                      \u2019 and \u2018onychomycosis\u2019. Meta\u2010analyses were performed using RevMan 5.4 and STATA 16.0 software.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 644 records were identified, with 29 articles included in the final analysis. Meta\u2010analysis indicated that compared with placebo, interleukin\u201017 (IL\u201017) inhibitors notably raised the risk of\n                      <jats:italic>Candida<\/jats:italic>\n                      infections (OR\u2009=\u20092.39, 95% CI\u2009=\u20091.84\u20133.11,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.00001), whereas tumour necrosis factor\u2010alpha (TNF\u2010\u03b1) inhibitors (OR\u2009=\u20091.75, 95% CI\u2009=\u20090.53\u20135.82,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.36) and interleukin\u201012\/23 (IL\u201012\/23) inhibitors (OR\u2009=\u20091.11, 95% CI\u2009=\u20090.27\u20134.63,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.88) showed no significant differences. Cross\u2010comparison demonstrated that IL\u201017 inhibitors had a higher risk of\n                      <jats:italic>Candida<\/jats:italic>\n                      infection compared to TNF\u2010\u03b1 inhibitors (OR\u2009=\u20092.23, 95% CI\u2009=\u20091.08\u20134.57,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03) and IL\u201012\/23 inhibitors (OR\u2009=\u20094.21, 95% CI\u2009=\u20092.71\u20136.55,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.00001). For dermatophyte infections, the overall risk associated with biologic agents was increased (OR\u2009=\u20091.89, 95% CI\u2009=\u20091.19\u20133.01,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007), IL\u201017 inhibitors showed a higher risk compared to IL\u201012\/23 inhibitors (OR\u2009=\u20092.70 95% CI\u2009=\u20091.29\u20135.63,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008). Overall, biologic agents significantly increased the risk of superficial fungal infections compared to placebo (OR\u2009=\u20092.10, 95% CI\u2009=\u20091.73\u20132.55,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.00001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Biologic agents, particularly IL\u201017 inhibitors, notably increase the risk of superficial fungal infections in psoriasis patients. In clinical practice, targeted monitoring protocols should be established, including regular follow\u2010up to promptly detect superficial fungal infections and initiate antifungal treatment as necessary.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>PROSPERO: CRD42025636705<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/myc.70081","type":"journal-article","created":{"date-parts":[[2025,6,21]],"date-time":"2025-06-21T03:21:14Z","timestamp":1750476074000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Biologic Therapy and Superficial Fungal Infection Risk in Moderate\u2010to\u2010Severe Psoriasis: A Meta\u2010Analysis"],"prefix":"10.1111","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0855-477X","authenticated-orcid":false,"given":"Heli","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Dermatology and Venereology Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital  Taiyuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Long","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital  Taiyuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziping","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital  Taiyuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2881-4458","authenticated-orcid":false,"given":"Ruijun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital  Taiyuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuying","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital  Taiyuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,21]]},"reference":[{"key":"e_1_2_12_2_1","volume-title":"Psoriasis","author":"Schreve B. 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