Global Increase in Dermatophyte Drug Resistance: a Rapidly Changing Map

Abstract

Due to globalization, human migration, and global animal transport and trade, the worldwide distribution of dermatophyte species has become more dynamic in recent decades. Thanks to the introduction of DNA sequencing studies, the current scenario of dermatophyte classification underwent significant changes a few years ago. Antimicrobial resistance is considered part of an inevitable evolutionary process in the microbial world. The overuse of antifungals is one of the key factors. Treatment for certain dermatophytoses is now a challenge. The emergence of terbinafine-resistant Trichophyton species has become a growing concern. Trichophyton indotineae, rapidly spread and now considered a cosmopolitan, emerged exhibiting resistance to one of the most used antifungals for its treatment, terbinafine.The use of antifungals in agriculture, empirical treatments and sometimes subtherapeutic doses have results in cases with poor clinical response to standard treatments and have made resistance or recalcitrance increasingly common in certain genera and species. The genus Trichophyton and certain species are a case in point. This review summarizes the genera and species of dermatophytes that show resistance to commonly used antifungals and treatment difficulties. Proper diagnosis and understanding of the current epidemiology of the different fungal species and their resistance are essential for developing an appropriate therapeutic strategy.