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Expert Panel Review of Skin and Hair Dermatophytoses in an Era of Antifungal Resistance

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Abstract

Dermatophytoses are fungal infections of the skin, hair, and nails that affect approximately 25% of the global population. Occlusive clothing, living in a hot humid environment, poor hygiene, proximity to animals, and crowded living conditions are important risk factors. Dermatophyte infections are named for the anatomic area they infect, and include tinea corporis, cruris, capitis, barbae, faciei, pedis, and manuum. Tinea incognito describes steroid-modified tinea. In some patients, especially those who are immunosuppressed or who have a history of corticosteroid use, dermatophyte infections may spread to involve extensive skin areas, and, in rare cases, may extend to the dermis and hair follicle. Over the past decade, dermatophytoses cases not responding to standard of care therapy have been increasingly reported. These cases are especially prevalent in the Indian subcontinent, and Trichophyton indotineae has been identified as the causative species, generating concern regarding resistance to available antifungal therapies. Antifungal-resistant dermatophyte infections have been recently recognized in the United States. Antifungal resistance is now a global health concern. When feasible, mycological confirmation before starting treatment is considered best practice. To curb antifungal-resistant infections, it is necessary for physicians to maintain a high index of suspicion for resistant dermatophyte infections coupled with antifungal stewardship efforts. Furthermore, by forging partnerships with federal agencies, state and local public health agencies, professional societies, and academic institutions, dermatologists can lead efforts to prevent the spread of antifungal-resistant dermatophytes.

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Authors and Affiliations

  1. Weill Cornell Medical College, New York, NY, USA

    Rachel C. Hill

  2. Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA

    Avrom S. Caplan

  3. Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, USA

    Boni Elewski

  4. Centers for Disease Control and Prevention, Mycotic Diseases Branch, Atlanta, GA, USA

    Jeremy A. W. Gold, Shawn R. Lockhart & Dallas J. Smith

  5. Department of Dermatology, Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10021, USA

    Shari R. Lipner

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Rachel C. Hill, Avrom S. Caplan, Boni Elewski, Jeremy A.W. Gold, Shawn R. Lockhart, Dallas J. Smith, and Shari R. Lipner have no conflicts of interest to declare.

Financial disclosures

Shari R. Lipner has served as a consultant for Ortho-Dermatologics, Eli Lilly, Moberg Pharmaceuticals, and BelleTorus Corporation.

Ethics approval

No ethical approval was required as this was a review study.

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Patient consent was not required as this was a review study.

Data/code availability

Data/code sharing are not applicable to this article as no datasets or code were generated and/or analyzed during the current study.

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Not applicable.

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Shari R. Lipner, MD, PhD.

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Authors’ contributions

RCH, ASC, BE, JAWG, SRLo, DJS, and SRLi have made substantial contributions to all aspects of the work. All authors read and approved the final version of the manuscript.

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Hill, R.C., Caplan, A.S., Elewski, B. et al. Expert Panel Review of Skin and Hair Dermatophytoses in an Era of Antifungal Resistance. Am J Clin Dermatol (2024). https://doi.org/10.1007/s40257-024-00848-1

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