A Bibliometric Analysis of the Top 100 Highly Cited Onychomycosis Publications Using SCOPUS Database (1972–2022)

Introduction: Onychomycosis represents half of nail disorders seen in clinical practice. Despite its high prevalence, a bibliometric analysis has not been performed. We aimed to identify the top 100 highly cited onychomycosis publications over the last 50 years to better understand research trends. Methods: SCOPUS was searched for onychomycosis publications, using “onychomycosis” and “nail fungus” 1/1/1972-12/31/22 on 3/25/23. Top 100 highly cited publications were recorded and ranked by total citation count. Results: Total citation count was 13,456, with the top 10 articles with highest citation count/year having average 28.7 citations/year. Most articles were published in high IF journals. From 1982 to 2011 (no treatment articles – 1972–1981), there was an 8.6% increase in articles discussing treatment. Overall, 42% of first authors were female. Conclusion: We found an overall increase in articles discussing onychomycosis therapies over time, with the majority published in high IF journals. We also found a relatively greater percentage of female first authors compared to studies on other dermatologic topics. While total citation count remains a widely used metric of impact in bibliometric studies, average citation count/year may be a better measure of impact and should be considered in future studies.


Introduction
Onychomycosis is the most common nail condition, accounting for 50% of all nail disorders seen in clinical practice, with worldwide prevalence of 5.5% [1,2].Onychomycosis may negatively affect patient's quality of life [3], by causing pain, impaired functionality, secondary bacterial infections, and/or social embarrassment.Bibliometric studies have been performed for dermatological conditions including atopic dermatitis, hidradenitis suppurativa, and nail psoriasis.Despite the high prevalence of onychomycosis, a bibliometric analysis of onychomycosis literature has not been previously performed.We aimed to identify the top 100 highly cited onychomycosis publications over the last 50 years to analyze citations, content, and authorship to better understand research trends.
Overall, 56% of first authors were male, 42% were female, 2% were unknown, and there was no significant relationship between gender and first author role (p > 0.05).The total citation count for publications with male versus female first authors was 7,465 versus 5,851 (χ 2 = 4.841, p = 0.0278), and the median journal IF for publications with male versus female first authors was 9.39 versus 10.33.There was no statistically significant difference in article type or study topic between male and female first authors (p > 0.05).

Discussion
We found that for the top 100 highly cited onychomycosis publications, the most frequent study topic was treatment, with an increase in onychomycosis articles discussing treatment over time.Similarly, in a bibliometric analysis of the top 50 highly cited nail psoriasis publications, the most frequent (48%) study topic was treatment, which might be due to increased approval of new psoriasis therapies [5].Similarly, there have been novel developments in the treatment of onychomycosis.Terbinafine was approved by the Food and Drug Administration (FDA) for treatment of onychomycosis in 1996, and topical ciclopirox was approved in 1999 [6].Fifteen years following the approval of topical ciclopirox, topical efinaconazole [7] and tavaborole [8] received FDA approval in 2014.
Therapies being studied of onychomycosis treatment include the systemic drugs, fosravuconazole L-lysine ethanolate, posaconazole, and a tetrazole, luliconazole 5% nail solution, and device-based therapies, such as plasma therapy and adjunctive nail trephination to heighten topical penetration [6].Therefore, the increase in treatment publications likely reflects relatively new onychomycosis drug approvals and drugs and devices under investigation.Less than 1/5 of the highly cited onychomycosis articles were published in the last decade.However, 9/ 10 publications with highest average citations per year were published within the last 10 years.While using total citation count is an easily quantifiable measure of impact, there is an inherent bias toward older articles since longer lifespans allow for more citing opportunities [9].Average citation count per year may be a better indicator of impact and considers age bias.Future bibliometric studies might benefit from including average citation per year as a variable.Moreover, it would be helpful if databases like SCOPUS included average citation per year as a metric to sort articles.

Table 1
(continued) Skin Appendage Disord 2023;9:333-341 DOI: 10.1159/000531184 of first author were obtained via Google search of author name.χ 2 analysis was performed to compare frequencies (p < 0.05).Ethical approval and consent were not required as this study was based on publicly available data.

Table 2 .
Characteristics of 100 cited onychomycosis publications (1972-2022) The most recent IF on record was used for each journal.b Includes editorial, guidelines, pharmacokinetic, cross-sectional survey, prospective, survey, molecular diagnostics.c Includes New England Journal of Medicine (176.10),Persoonia: Molecular Phylogeny and Evolution of Fungi, Clinical Microbiology and Infection (11.26),Indian Journal of Dermatology, Venereology and Leprology (2.55), Indian Journal of Medical Microbiology (0.99), Clinical Pharmacokinetics (6.45), Journal of Cutaneous Medicine and Surgery (2.09), Bioorganic and Medicinal Chemistry ( a