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

Abstract

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.

Materials and Methods

The SCOPUS database [4] was accessed on 3/25/23 for onychomycosis publications (searching field category “onychomycosis” and “nail fungus”) from 1/1/1972 to 12/31/22. The top 100 highly cited publications were recorded and ranked by total citation count. Articles not relevant to onychomycosis were excluded. Authorship, journal title, most recently published journal impact factor (IF), article type, study topic, year of publication, total citation count, and average citation count per year were recorded. Country affiliation and gender of first author were obtained via Google search of author name. χ² 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.

Results

For the top 100 highly cited onychomycosis publications (Table 1), the total citation count was 13,456, with the top 10 most cited articles accounting for 28.8% of the total citation count (Table 2). The top 10 articles with the highest citation count/year had an average of 28.7 citations per year and were all published post-2010, except for one publication in 1995. From 1972 to 2022, the majority of articles were published between 2002 and –2011 (38%), followed by 1992–2001 (33%), 2012–2022 (18%), 1982–1991 (2%), and 1972–1981 (9%) (Fig. 1). The top 100 highly cited articles were published in 40 different journals, with most published in the Journal of the American Academy of Dermatology (n = 20), followed by the British Journal of Dermatology (n = 9). The mean and median IF of journals were 12.25 and 9.55, respectively (range 0.99–176.1). The most frequent article types were reviews (49%), followed by comparative studies (13%) and randomized-controlled trials (11%). The most frequent topics included treatment (38%), overview of onychomycosis (31%), and diagnosis (16%). From 1982 to 2011 (no treatment articles – 1972–1981), there was an 8.6% increase in articles discussing treatment, and from 1972 to 2011 an 11.5% increase in overview articles (Fig. 2). Articles originated from 28 different countries, with the USA (27%), UK (10%), Canada (9%), and Germany (9%) as the most frequently contributing countries.

Table 1.

Top 100 cited onychomycosis publications (1972–2022)

Rank	Title	Journal	Year	Times cited	Times cited/year	Article type
1	The dermatophytes	Clinical Microbiology Reviews	1995	935	33.4	Review
2	The biology and chemistry of antifungal agents: A review	Bioorganic and Medicinal Chemistry	2012	496	45.1	Review
3	Onychomycosis: Pathogenesis, diagnosis, and management	Clinical Microbiology Reviews	1998	454	18.2	Review
4	A large-scale North American study of fungal isolates from nails: The frequency of onychomycosis, fungal distribution, and antifungal susceptibility patterns	Journal of the American Academy of Dermatology	2000	444	19.3	Multicenter
5	Prevalence and epidemiology of toenail onychomycosis in diabetic subjects: A multicentre survey	British Journal of Dermatology	1998	301	12.0	Multicenter
6	Onychomycosis	Archives of Dermatology	1972	278	5.5	Review
7	Terbinafine: A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in superficial mycoses	Drugs	1992	258	8.3	Review
8	Onychomycosis, tinea pedis and tinea manuum caused by non-dermatophytic filamentous fungi	Mycoses	1989	245	7.2	Case series
9	Comparison of diagnostic methods in the evaluation of onychomycosis	Journal of the American Academy of Dermatology	2003	234	11.7	Comparative
10	Prevalence of onychomycosis in patients attending a dermatology clinic in Northeastern Ohio for other conditions	Archives of Dermatology	1997	229	8.8	Cross-sectional survey
11	Efinaconazole 10% solution in the treatment of toenail onychomycosis: Two phase III multicenter, randomized, double-blind studies	Journal of the American Academy of Dermatology	2013	216	21.6	RCT
12	Nails and fungi	British Journal of Dermatology	1976	212	4.5	Review
13	A U.S. epidemiologic survey of superficial fungal diseases	Journal of the American Academy of Dermatology	1996	210	7.8	Survey
14	Mycology-an update. Part 1: Dermatomycoses: Causative agents, epidemiology and pathogenesis	JDDG – Journal of the German Society of Dermatology	2014	203	22.6	Review
15	Dermatophyte infections	American Family Physician	2003	191	9.6	Review
16	Systematic review of nondermatophyte mold onychomycosis: Diagnosis, clinical types, epidemiology, and treatment	Journal of the American Academy of Dermatology	2012	189	17.2	Review
17	Fungal planet description sheets: 400–468	Persoonia: Molecular Phylogeny and Evolution of Fungi	2016	187	26.7	Review
18	Antifungal pulse therapy for onychomycosis: A pharmacokinetic and pharmacodynamic investigation of monthly cycles of 1-week pulse therapy with itraconazole	Archives of Dermatology	1996	187	6.9	RCT
19	Guidelines for treatment of onychomycosis	British Journal of Dermatology	2003	179	9.0	Guidelines
20	Mycology of nail disorders	Journal of the American Academy of Dermatology	1994	171	5.9	Review
21	Onychomycosis	Clinics in Dermatology	2010	170	13.1	Review
22	Fungal infections of the nail	Seminars in Dermatology	1991	157	4.9	Review
23	Alternaria infections: Laboratory diagnosis and relevant clinical features	Clinical Microbiology and Infection	2008	155	10.3	Review
24	Clinical features of human infection with scedosporium inflatum	Clinical Infectious Diseases	1992	152	4.9	Case series
25	Methods for diagnosing onychomycosis: A comparative study and review of the literature	Archives of Dermatology	2000	148	6.4	Review
26	Onychomycosis: Clinical overview and diagnosis	Journal of the American Academy of Dermatology	2019	144	36.0	Review
27	Epidemiology and clinical classification of onychomycosis	Journal of the European Academy of Dermatology and Venereology	2005	134	7.4	Comparative
28	Antifungal agents	Medical Journal of Australia	2007	131	8.2	Review
29	Randomized double blind comparison of terbinafine and itraconazole for treatment of toenail tinea infection	British Medical Journal	1995	129	4.6	RCT
30	Onychomycosis in the 21st century: An update on diagnosis, epidemiology, and treatment	Journal of Cutaneous Medicine and Surgery	2017	126	21.0	Review
31	Onychomycosis: Treatment and prevention of recurrence	Journal of the American Academy of Dermatology	2019	123	30.8	Review
32	Identification of dermatophyte species causing onychomycosis and tinea pedis by MALDI-TOF mass spectrometry	Experimental Dermatology	2008	122	8.1	Comparative
33	Comparison of in vitro antifungal activities of efinaconazole and currently available antifungal agents against a variety of pathogenic fungi associated with onychomycosis	Antimicrobial Agents and Chemotherapy	2013	120	12.0	Comparative
34	Onychomycosis: A proposed revision of the clinical classification	Journal of the American Academy of Dermatology	2011	119	9.9	Editorial
35	Deep neural networks show an equivalent and often superior performance to dermatologists in onychomycosis diagnosis: Automatic construction of onychomycosis datasets by region-based convolutional deep neural network	Antimicrobial Agents and Chemotherapy	2018	118	23.6	Comparative
36	Five-hour diagnosis of dermatophyte nail infections with specific detection of Trichophyton rubrum	Journal of Clinical Microbiology	2007	117	7.3	Validation
37	A new classification system for grading the severity of onychomycosis: Onychomycosis severity index	Archives of Dermatology	2011	116	9.7	Consensus
38	Candida onychomycosis—an evaluation of the role of Candida species in nail disease	British Journal of Dermatology	1988	115	3.3	Review
39	Toenail onychomycosis: Current and future treatment options	Dermatologic Therapy	2007	114	7.1	Review
40	In vitro penetration of a novel oxaborole antifungal (AN2690) into the human nail plate	Journal of Pharmaceutical Sciences	2007	111	6.9	Comparative
41	Non-dermatophytes in onychomycosis of the toenails	British Journal of Dermatology	1997	111	4.3	RCT
42	Causative agents of onychomycosis – A retrospective study	JDDG – Journal of the German Society of Dermatology	2006	110	6.5	Retrospective
43	Other fungi causing onychomycosis	Clinics in Dermatology	2010	109	8.4	Review
44	Superficial fungal infections in 102 renal transplant recipients: A case-control study	Journal of the American Academy of Dermatology	2003	109	5.5	Case-control
45	An evaluation of itraconazole in the management of onychomycosis	British Journal of Dermatology	1988	109	3.1	RCT
46	Ciclopirox: Recent nonclinical and clinical data relevant to its use as a topical antimycotic agent	Drugs	2010	108	8.3	Review
47	Bifonazole: A review of its antimicrobial activity and therapeutic use in superficial mycoses	Drugs	1989	105	3.1	Review
48	Onychomycosis: A critical study of techniques and criteria for confirming the etiologic significance of nondermatophytes	Medical Mycology	2005	104	5.8	Review
49	Twelve weeks of continuous oral therapy for toenail onychomycosis caused by dermatophytes: A double-blind comparative trial of terbinafine 250 mg/day versus itraconazole 200 mg/day	Journal of the American Academy of Dermatology	1998	104	4.2	RCT
50	Laser treatment of onychomycosis using a novel 0.65-millisecond pulsed Nd:YAG 1064-nm laser	Journal of Cosmetic and Laser Therapy	2011	103	8.6	RCT
51	Terbinafine. An update of its use in superficial mycoses	Drugs	1999	102	4.3	Review
52	Nail changes in patients infected with human immunodeficiency virus: A prospective controlled study	Archives of Dermatology	1998	102	4.1	Prospective
53	Fungal nail disease	New England Journal of Medicine	2009	100	7.1	Review
54	Nail incorporation kinetics of terbinafine in onychomycosis patients	Clinical and Experimental Dermatology	1995	100	3.6	Pharmacokinetic
55	Terbinafine: A review of its use in onychomycosis in adults	American Journal of Clinical Dermatology	2003	98	4.9	Review
56	Onychomycosis in Denmark: Prevalence of fungal nail infection in general practice	Mycoses	2004	94	4.9	Observational
57	Treatment failures and relapses in onychomycosis: A stubborn clinical problem	Dermatology	2003	94	4.7	Review
58	Diagnostic techniques for confirming onychomycosis	Journal of the American Academy of Dermatology	1996	93	3.4	Review
59	Causative pathogens in onychomycosis and the possibility of treatment resistance: A review	Journal of the American Academy of Dermatology	1998	90	3.6	Review
60	The future of onychomycosis therapy may involve a combination of approaches	British Journal of Dermatology, Supplement	2001	89	4.0	Review
61	Dermatophyte resistance to antifungal drugs: Mechanisms and prospectus	Frontiers in Microbiology	2018	88	17.6	Review
62	Topical therapy for fungal infections	American Journal of Clinical Dermatology	2004	87	4.6	Review
63	In vitro activity of fluconazole, itraconazole, voriconazole and terbinafine against fungi causing onychomycosis	Clinical and Experimental Dermatology	2010	82	6.3	Experimental
64	Forty-eight-hour diagnosis of onychomycosis with subtyping of Trichophyton rubrum strains	Journal of Clinical Microbiology	2006	82	4.8	Molecular diagnostic
65	Common tinea infections in children	American Family Physician	2008	81	5.4	Review
66	Fungal nail infections (onychomycosis): A never-ending story?	PLOS Pathogens	2014	80	8.9	Review
67	Fusarium spp. as agents of onychomycosis in immunocompetent hosts	International Journal of Dermatology	2007	80	5.0	Observational
68	A risk-benefit assessment of the newer oral antifungal agents used to treat onychomycosis	Drug Safety	2000	80	3.5	Review
69	Amorolfine: A review of its pharmacological properties and therapeutic potential in the treatment of onychomycosis and other superficial fungal infections	Drugs	1995	80	2.9	Review
70	Onychomycosis	Dermatologic Clinics	1985	80	2.1	Review
71	Onychomycosis: A review	Journal of Fungi	2015	79	9.9	Review
72	Treatment of onychomycosis using a submillisecond 1064-nm neodymium:yttrium-aluminum-garnet laser	Journal of the American Academy of Dermatology	2013	78	7.8	Comparative
73	Cost-effectiveness of diagnostic tests for toenail onychomycosis: A repeated-measure, single-blinded, cross-sectional evaluation of 7 diagnostic tests	Journal of the American Academy of Dermatology	2006	78	4.6	Comparative
74	Update on the management of onychomycosis: Highlights on the Third Annual International Summit on Cutaneous Antifungal Therapy	Clinical Infectious Diseases	1996	78	2.9	Review
75	Onychomycosis: A review	Journal of the European Academy of Dermatology and Venereology	2020	77	25.7	Review
76	Rare and new etiological agents revealed among 178 clinical Aspergillus strains obtained from Czech patients and characterized by molecular sequencing	Medical Mycology	2012	77	7.0	Observational
77	Histopathological diagnosis of onychomycosis by periodic acid-Schiff-stained nail clippings	British Journal of Dermatology	2003	76	3.8	Comparative
78	Present and potential diagnostic techniques in onychomycosis	Journal of the American Academy of Dermatology	1996	76	2.8	Review
79	Usefulness of histological examination for the diagnosis of onychomycosis	Dermatology	2001	75	3.4	Comparative
80	Pharmacokinetics of antifungal agents in onychomycoses	Clinical Pharmacokinetics	2001	75	3.4	Review
81	Photodynamic treatment of the dermatophyte Trichophyton rubrum and its microconidia with porphyrin photosensitizers	Photochemistry and Photobiology	2004	72	3.8	Experimental
82	Systematic review of topical treatments for fungal infections of the skin and nails of the feet	British Medical Journal	1999	72	3.0	Systematic review
83	Terbinafine in onychomycosis of the toenail: A novel treatment protocol	Journal of the American Academy of Dermatology	1995	72	2.6	RCT
84	Onychomycosis: Diagnosis and management	Indian Journal of Dermatology, Venereology and Leprology	2011	71	5.9	Review
85	Study of onychomycosis: Prevailing fungi and pattern of infection	Indian Journal of Medical Microbiology	2007	71	4.4	Observational
86	A method for the determination of drug effectiveness in onychomycosis: Trials with ketoconazole and griseofulvin ultramicrosize	Journal of the American Academy of Dermatology	1983	71	1.8	RCT
87	Confocal laser scanning microscopy as a new valuable tool in the diagnosis of onychomycosis – comparison of six diagnostic methods	Mycoses	2013	70	7.0	Comparative
88	Fungal melanonychia	Journal of the American Academy of Dermatology	2012	70	6.4	Review
89	Therapeutic efficacy of topically applied KP-103 against experimental tinea unguium in guinea pigs in comparison with amorolfine and terbinafine	Antimicrobial Agents and Chemotherapy	2002	70	3.3	Comparative
90	Onychomycosis in Lahore, Pakistan	International Journal of Dermatology	1999	70	2.9	Observational
91	Molds in onychomycosis	International Journal of Dermatology	1993	70	2.3	Experimental
92	Epidemiology of dermatophyte infections in Stockholm, Sweden: A retrospective study from 2005–2009	Medical Mycology	2011	69	5.8	Observational
93	Candidal onychomycosis: A mini-review	Mycopathologia	2009	69	4.9	Review
94	A phase I/II randomized, double-blind, placebo-controlled, dose-ranging study evaluating the efficacy, safety and pharmacokinetics of ravuconazole in the treatment of onychomycosis	Journal of the European Academy of Dermatology and Venereology	2005	69	3.8	RCT
95	Utility of inoculum counting (Walshe and English criteria) in clinical diagnosis of onychomycosis caused by nondermatophytic filamentous fungi	Journal of Clinical Microbiology	2001	68	3.1	Observational
96	Study of onychomycosis in Cordoba, Spain: Prevailing fungi and pattern of infection	Mycopathologia	1997	68	2.6	Comparative
97	Short-duration treatment of fingernail dermatophytosis: A randomized, double-blind study with terbinafine and griseofulvin	Journal of the American Academy of Dermatology	1995	68	2.4	RCT
98	Determination of terbinafine in nail samples during systemic treatment for onychomycoses	British Journal of Dermatology	1990	68	2.1	Experimental
99	Dermatophyte onychomycosis in children	Clinical and Experimental Dermatology	1989	68	2.0	Laboratory based
100	The susceptibility of dermatophytes to photodynamic treatment with special focus on Trichophyton rubrum	Photochemistry and Photobiology	2011	67	5.6	Review

RCT, Randomized-controlled trial.

Table 2.

Characteristics of 100 cited onychomycosis publications (1972–2022)

Publication information	Publication (n or %)	Publication information	Publication (n or %)
Journal title (IF a )		Article type
Journal of the American Academy of Dermatology (11.53)	20	Review (literature/systematic)	49
British Journal of Dermatology (11.11)	9	Comparative	13
Archives of Dermatology (11.82)	6	RCT	11
Drugs (9.55)	5	Observational	7
Journal of the European Academy of Dermatology and Venereology (9.23)	3	Experimental	5
Medical Mycology (3.75)	3	Case series	2
Mycoses (4.93)	3	Multicenter	2
Clinical and Experimental Dermatology (3.47)	3	Otherb	11
Journal of Clinical Microbiology (11.68)	3	Study topic
International Journal of Dermatology (1.31)	3	Treatment	38
Antimicrobial Agents and Chemotherapy (5.95)	3	General	31
Clinical Infectious Diseases (21.00)	2	Diagnosis	16
British Medical Journal (96.22)	2	Etiology	9
American Journal of Clinical Dermatology (7.40)	2	Epidemiology	4
American Family Physician (1.97)	2	Risk factors	1
Clinical Microbiology Reviews (50.13)	2	Novel fungal species	1
Clinics in Dermatology (2.47)	2	Country of first author affiliation
Dermatology (1.10)	2	USA	27
JDDG – Journal of the German Society of Dermatology (5.23)	2	UK	10
Photochemistry and Photobiology (2.21)	2	Canada	9
Mycopathologia (3.79)	2	Germany	9
Otherc	18	Australia	4
Citation count		Belgium	4
Total	13,456	Italy	4
Mean	134.6	India	4
Median	102.5	New Zealand	3
Range	67-496	Brazil	2
Average citations per year		Wales	2
Mean	8.473	France	2
Median	5.8	Netherlands	2
Range	1.8–45.1	Spain	2
IF a		Mexico	2
Mean	12.25	Otherd	12
Median	9.55	Gender of first author
Range	0.99–176.1	Male	56
		Female	42
		Unknown	2

RCT, Randomized-controlled trial.

^aThe most recent IF on record was used for each journal.

^bIncludes editorial, guidelines, pharmacokinetic, cross-sectional survey, prospective, survey, molecular diagnostics.

^cIncludes 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 (3.64), Dermatologic Clinics (3.21), Dermatologic Therapy (3.86), Journal of Pharmaceutical Sciences (3.78), PLOS Pathogens (7.46), Seminars in Dermatology (1.31), Journal of Fungi (5.72), Journal of Cosmetic and Laser Therapy (1.11), Drug Safety (5.61), Frontiers in Microbiology (6.06), Experimental Dermatology (3.47), Medical Journal of Australia (7.70).

^dIncludes Austria, Bulgaria, Columbia Czech Republic, Poland, Denmark, Japan, Pakistan, South Africa, Sri Lanka, Sweden, Turkey.

Fig. 1.

Rate of publications and citations (1972–2022).

Fig. 2.

Number of top cited publications by time frame and study topic (1972–2021).

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 (χ² = 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.

We also found that 42% of first authorship positions of top 100 onychomycosis publications were held by women, and articles by female first authors were published in journals with higher median IF than males. In a bibliometric analysis of top dermatology authors by h-index, female comprised 0% of authors in 1980–1989, which increased to 19% in 2010–2019 [10]. In another bibliometric analysis of 100 highly cited nail psoriasis publications, 32% of first authors were female [11]. Though it is unclear why there is a relatively greater percentage of female authors for onychomycosis publications, it demonstrates better representation of female authors compared to studies on other dermatologic topics. Still, gender disparities exist. A quantitative observational study demonstrated that while females comprise almost half of all US and Canada dermatologists, only 26.1% of faculty heads are females and the median publications for male versus female dermatology professors were 94.5 versus 15.5, which is nearly six times less than male professors [12]. Since research output is one measure of academic success, it is important to acknowledge persistent gender gaps and provide more support and opportunities for female dermatologists.

Limitations include only using the SCOPUS database, which may potentially exclude relevant articles. While we calculated average citations per year, by using total citation count as the ranking criteria to initially obtain the top 100 onychomycosis publications, there is intrinsic bias toward older articles.

Conclusion

To our knowledge, this is the first bibliometric analysis of the onychomycosis literature. We found an overall increase in articles discussing onychomycosis treatment over time, with the majority published in high IF journals. We also found that a relatively greater percentage of first authors were female compared to studies on other dermatologic topics. Our analysis invites reflection on bibliometric analyses. While total citation count remains a widely used measure of impact in bibliometric studies, average citation count per year may be a better indicator of impact and should be considered in future studies.

Statement of Ethics

Ethics approval was not required due to local and national guidelines. Informed consent was not required as there were no patients involved in this study.

Conflict of Interest Statement

Ms. Albucker has no relevant conflicts of interest to disclose. Dr. Lipner has served as a consultant for Ortho Dermatologics, Hoth Therapeutics, BelleTorus Corporation, and Moberg Pharmaceuticals.

Funding Sources

The authors did not receive any funding to complete this research.

Author Contributions

Ms. Albucker and Dr. Lipner both contributed to the conception, drafting, and revising of the work, as well as final approval of the version to be published, and agreed to be accountable for all parts of the work, ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Funding Statement

The authors did not receive any funding to complete this research.

Data Availability Statement

All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.