{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T03:15:09Z","timestamp":1788491709425,"version":"build-2803163510"},"reference-count":126,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"National Institute for Health","award":["1R01AI177604"],"award-info":[{"award-number":["1R01AI177604"]}]},{"DOI":"10.13039\/100006492","name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006492","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plospathogens.org"],"crossmark-restriction":false},"short-container-title":["PLoS Pathog"],"abstract":"<jats:p>\n                    <jats:italic>Candida auris<\/jats:italic>\n                    is an emerging, multidrug-resistant fungal pathogen that causes healthcare-associated outbreaks and life-threatening systemic infections. Unlike other\n                    <jats:italic>Candida<\/jats:italic>\n                    species,\n                    <jats:italic>C. auris<\/jats:italic>\n                    exhibits a distinct capacity for persistent skin colonization. In this review, we summarize our current understanding of clinical risk factors and host-microbe interactions that underlie\n                    <jats:italic>C. auris<\/jats:italic>\n                    skin colonization and infection. We discuss fungal determinants, including the unique mannan outer layer, fungal adhesins, the protein kinase Hog1, and other pathways in\n                    <jats:italic>C. auris<\/jats:italic>\n                    that govern adaptation in the skin. Furthermore, we highlight host immune mechanisms, including cytokine mediators (IL-1Ra, IL-17) and innate immune cells (neutrophils, macrophages, innate lymphocytes), that shape the outcome of\n                    <jats:italic>C. auris<\/jats:italic>\n                    skin colonization and infection. We also discuss how excessive IFN-\u03b3 responses drive epithelial pathology at the cutaneous barrier and enhance fungal persistence. Finally, we outline emerging research directions to understand host and microbe factors governing long-term colonization, with implications for developing novel therapeutic and vaccine strategies against this skin-tropic, multidrug-resistant fungal pathogen.\n                  <\/jats:p>","DOI":"10.1371\/journal.ppat.1014075","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T17:22:05Z","timestamp":1774632125000},"page":"e1014075","update-policy":"https:\/\/doi.org\/10.1371\/journal.ppat.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Host\u2013Candida auris interactions in the skin"],"prefix":"10.1371","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0031-2392","authenticated-orcid":true,"given":"Shankar","family":"Thangamani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abishek","family":"Balakumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhishek","family":"Datta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garrett","family":"Bryak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michail S.","family":"Lionakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"ppat.1014075.ref001","volume-title":"WHO fungal priority pathogens list to guide research, development and public health action","year":"2022"},{"issue":"9","key":"ppat.1014075.ref002","doi-asserted-by":"crossref","first-page":"100903","DOI":"10.1016\/S2666-5247(24)00135-6","article-title":"The diverse genomes of Candida auris","volume":"5","author":"H Gifford","year":"2024","journal-title":"Lancet Microbe"},{"issue":"2","key":"ppat.1014075.ref003","doi-asserted-by":"crossref","DOI":"10.1016\/j.chom.2020.12.002","article-title":"Murine model of colonization with fungal pathogen Candida auris to explore skin tropism, host risk factors and therapeutic strategies","volume":"29","author":"X Huang","year":"2021","journal-title":"Cell Host Microbe"},{"issue":"4","key":"ppat.1014075.ref004","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/j.chom.2023.02.010","article-title":"One population, multiple lifestyles: commensalism and pathogenesis in the human mycobiome","volume":"31","author":"DM Proctor","year":"2023","journal-title":"Cell Host Microbe"},{"issue":"20","key":"ppat.1014075.ref005","doi-asserted-by":"crossref","first-page":"1924","DOI":"10.1056\/NEJMra2402635","article-title":"Candida auris Infections","volume":"391","author":"MS Lionakis","year":"2024","journal-title":"N Engl J Med"},{"issue":"6665","key":"ppat.1014075.ref006","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1126\/science.adf8972","article-title":"A Candida auris-specific adhesin, Scf1, governs surface association, colonization, and virulence","volume":"381","author":"DJ Santana","year":"2023","journal-title":"Science"},{"issue":"8","key":"ppat.1014075.ref007","doi-asserted-by":"crossref","DOI":"10.1128\/spectrum.00127-24","article-title":"Intradermal infection and dissemination of Candida auris in immunocompetent and immunocompromised mouse models","volume":"12","author":"KA Towns","year":"2024","journal-title":"Microbiol Spectr"},{"key":"ppat.1014075.ref008","doi-asserted-by":"crossref","first-page":"22","DOI":"10.3767\/persoonia.2024.52.02","article-title":"Phylogenomic analysis of the Candida auris-Candida haemuli clade and related taxa in the Metschnikowiaceae, and proposal of thirteen new genera, fifty-five new combinations and nine new species","volume":"52","author":"F Liu","year":"2024","journal-title":"Persoonia"},{"issue":"10","key":"ppat.1014075.ref009","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.1093\/infdis\/jiac094","article-title":"Ex vivo human and porcine skin effectively model Candida auris colonization, differentiating robust and poor fungal colonizers","volume":"225","author":"EF Eix","year":"2022","journal-title":"J Infect Dis"},{"issue":"3","key":"ppat.1014075.ref010","doi-asserted-by":"crossref","DOI":"10.1016\/j.chom.2019.02.002","article-title":"The skin commensal yeast malassezia triggers a type 17 response that coordinates anti-fungal immunity and exacerbates skin inflammation","volume":"25","author":"F Sparber","year":"2019","journal-title":"Cell Host Microbe"},{"issue":"1","key":"ppat.1014075.ref011","doi-asserted-by":"crossref","first-page":"5673","DOI":"10.1038\/s41467-025-60876-1","article-title":"Adhesin Als4112 promotes Candida auris skin colonization through interactions with keratinocytes and extracellular matrix proteins","volume":"16","author":"G Zhao","year":"2025","journal-title":"Nat Commun"},{"issue":"8","key":"ppat.1014075.ref012","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1038\/s41591-021-01383-w","article-title":"Integrated genomic, epidemiologic investigation of Candida auris skin colonization in a skilled nursing facility","volume":"27","author":"DM Proctor","year":"2021","journal-title":"Nat Med"},{"issue":"8056","key":"ppat.1014075.ref013","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1038\/s41586-025-08608-9","article-title":"Clonal Candida auris and ESKAPE pathogens on the skin of residents of nursing homes","volume":"639","author":"DM Proctor","year":"2025","journal-title":"Nature"},{"issue":"4","key":"ppat.1014075.ref014","doi-asserted-by":"crossref","first-page":"489","DOI":"10.7326\/M22-3469","article-title":"Worsening spread of Candida auris in the United States, 2019 to 2021","volume":"176","author":"M Lyman","year":"2023","journal-title":"Ann Intern Med"},{"issue":"2","key":"ppat.1014075.ref015","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1093\/cid\/ciw691","article-title":"Simultaneous emergence of multidrug-resistant Candida auris on 3 continents confirmed by whole-genome sequencing and epidemiological analyses","volume":"64","author":"SR Lockhart","year":"2017","journal-title":"Clin Infect Dis"},{"issue":"29","key":"ppat.1014075.ref016","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.15585\/mmwr.mm7029a2","article-title":"Notes from the field: transmission of pan-resistant and echinocandin-resistant Candida auris in health care 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keratinocytes","volume":"35","author":"C Yao","year":"2015","journal-title":"Int J Mol Med"},{"issue":"6","key":"ppat.1014075.ref037","first-page":"762","article-title":"Persistent colonization of","volume":"45","author":"SP Arenas","year":"2024","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"12","key":"ppat.1014075.ref038","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.3390\/antibiotics14121206","article-title":"Risk factors and outcomes for invasive infection among patients colonized with Candidozyma auris: a case-control study","volume":"14","author":"SA Alowais","year":"2025","journal-title":"Antibiotics (Basel)"},{"key":"ppat.1014075.ref039","article-title":"Risk factors associated with progression to clinical Candida auris infection among adults with previous colonization-Florida, 2019-2023","author":"KE Saunders","year":"2025","journal-title":"Clin Infect Dis"},{"issue":"5","key":"ppat.1014075.ref040","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1007\/s15010-018-1164-y","article-title":"Invasive Candida auris infections in Kuwait hospitals: epidemiology, antifungal treatment and outcome","volume":"46","author":"Z Khan","year":"2018","journal-title":"Infection"},{"issue":"1","key":"ppat.1014075.ref041","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0313589","article-title":"An overview of healthcare-associated Candida auris outbreaks in Ministry of Health hospitals-Saudi Arabia 2020-2022; retrospective multicentric study","volume":"20","author":"KH Alanazi","year":"2025","journal-title":"PLoS One"},{"issue":"1","key":"ppat.1014075.ref042","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.jiph.2023.11.021","article-title":"Risk factors, antifungal susceptibility, complications, and outcome of Candida auris bloodstream infection in a tertiary care center in the western region of Saudi 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Katsiari","year":"2025","journal-title":"Pathogens"},{"issue":"1","key":"ppat.1014075.ref055","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/s00296-014-3030-2","article-title":"The in vitro addition of methotrexate and\/or methylprednisolone determines peripheral reduction in Th17 and expansion of conventional Treg and of IL-10 producing Th17 lymphocytes in patients with early rheumatoid arthritis","volume":"35","author":"G Guggino","year":"2015","journal-title":"Rheumatol Int"},{"issue":"9398","key":"ppat.1014075.ref056","doi-asserted-by":"crossref","first-page":"1828","DOI":"10.1016\/S0140-6736(03)14904-5","article-title":"Glucocorticoids and invasive fungal infections","volume":"362","author":"MS Lionakis","year":"2003","journal-title":"Lancet"},{"issue":"5","key":"ppat.1014075.ref057","article-title":"Experimental mouse models of disseminated Candida auris infection","volume":"4","author":"H Xin","year":"2019","journal-title":"mSphere"},{"issue":"1","key":"ppat.1014075.ref058","first-page":"195","article-title":"Multidrug-resistant Candida haemulonii and C. auris, Tel Aviv, Israel","volume":"23","author":"R Ben-Ami","year":"2017","journal-title":"Emerg Infect Dis"},{"key":"ppat.1014075.ref059","doi-asserted-by":"crossref","first-page":"18026","DOI":"10.1038\/nrdp.2018.26","article-title":"Invasive candidiasis","volume":"4","author":"PG Pappas","year":"2018","journal-title":"Nat Rev Dis Primers"},{"issue":"3","key":"ppat.1014075.ref060","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1111\/jam.13929","article-title":"Shift in skin microbiota of Western European women across aging","volume":"125","author":"R Jug\u00e9","year":"2018","journal-title":"J Appl Microbiol"},{"issue":"1","key":"ppat.1014075.ref061","doi-asserted-by":"crossref","first-page":"16748","DOI":"10.1038\/s41598-019-53266-3","article-title":"Segregation of age-related skin microbiome 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