Title : Antifungal resistance in dermatophytes: A growing concern
Abstract:
Dermatophytes are a group of keratinophilic fungi responsible for superficial infections of the skin, hair and nails collectively known as dermatophytosis.In recent years, there has been a notable rise in antifungal resistance among dermatophyte species, posing a significant public health challenge globally. Traditionally, infections caused by dermatophytes are effectively managed using topical and systemic antifungal agents, particularly azoles and allylamines. However, emerging resistance-specially to terbinafine has been increasingly documented among Trichophyton species, including Trichophyton indotineae, which is linked to widespread treatment failures in certain regions. Contributing factorsinclude irrational use of antifungal medications, poor patient compliance, over the counter availability of topical steroid antifungal combinations, and lack of susceptibility testing in routine clinical practice. This paper explores the current understanding of the mechanisms behind antifungal resistance in dermatophytes such as gene mutations in squalene epoxidase, biofilm formation and efflux pump over expression. Furthermore, the article discusses clinical and diagnostic challenges, gaps in laboratory antifungal susceptibility testing,and the need for standardized protocols to guide effective treatment. With the global burden of dermatophytosis on the rise, specially in tropical and subtropical regions, there is an urgent need for robust surveillance systems, antifungal stewardship and the development of novel therapeutic agents to effectively combat this emerging threat.
