Antifungal Resistance, Susceptibility Testing and Treatment of Recalcitrant Dermatophytosis Caused by Trichophyton indotineae: A North American Perspective on Management

Gupta, Aditya K.; Ravi, Shruthi Polla; Wang, Tong; Cooper, Elizabeth A.; Lincoln, Sara A.; Foreman, Hui-Chen Chang; Bakotic, Wayne L.

doi:10.1007/s40257-023-00811-6

Cited by 8 publications

(12 citation statements)

References 63 publications

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“…Since multidrug resistance is a possibility, combination therapy of oral and topical agents (e.g., itraconazole and ciclopirox) needs to be further investigated. 7…”

Section: Superficial Mycoses 1| Tinea Corporis/cruris/pedismentioning

confidence: 99%

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A clinical update on fungal disease of human skin

Burningham,

Kim,

Kashyap

et al. 2024

Dermatological Reviews

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“…Since multidrug resistance is a possibility, combination therapy of oral and topical agents (e.g., itraconazole and ciclopirox) needs to be further investigated. 7…”

Section: Superficial Mycoses 1| Tinea Corporis/cruris/pedismentioning

confidence: 99%

“…Proposed treatments for this new strain include supra‐standard dosing and duration of itraconazole, with or without simultaneous topical therapy. Since multidrug resistance is a possibility, combination therapy of oral and topical agents (e.g., itraconazole and ciclopirox) needs to be further investigated 7 …”

Section: Superficial Mycosesmentioning

confidence: 99%

A clinical update on fungal disease of human skin

Burningham,

Kim,

Kashyap

et al. 2024

Dermatological Reviews

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“…To date, established breakpoints to assess dermatophyte resistance to specific antimycotic agents are lacking. Notably, a limitation of this approach is that MICs may not consistently predict clinical response [ 27 , 28 ].…”

Section: Treatment Of Dermatophytosis and Emergence Of Antifungal Res...mentioning

confidence: 99%

“…However, one of the most commonly reported mechanisms in T. indotineae involves point mutations in the squalene epoxidase ( SQLE ) gene, ERG1 , which have been associated with terbinafine resistance. These mutations ultimately alter terbinafine binding to the SQLE enzyme [ 27 ].…”

Section: Resistance Mechanisms In T Indotineaementioning

confidence: 99%

“…Compared to the wild-type, T. indotineae isolates with Phe397Leu and Leu393Ser SQLE mutations demonstrate reduced susceptibility to terbinafine in vitro [ 27 ]. Conversely, the Ala448Thr mutant exhibits higher susceptibility to terbinafine, although it is subject to debate whether this mutant may be less sensitive to azoles [ 62 , 63 ].…”

Section: Resistance Mechanisms In T Indotineaementioning

confidence: 99%

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Trichophyton indotineae, an Emerging Drug-Resistant Dermatophyte: A Review of the Treatment Options

Sonego,

Corio,

Mazzoletti

et al. 2024

JCM

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Background: Dermatophytosis is a prevalent superficial infection caused by filamentous fungi, primarily affecting the skin and/or its appendages. In recent years, there has been a notable increase in mycotic strains resistant to standard antifungal therapies, including Trichophyton indotineae, a dermatophyte of the Trichophyton mentagrophytes complex. This review aims to provide a comprehensive overview of the treatment options for T. indotineae, elucidating their effectiveness in managing this challenging mycotic infection. Methods: For this review, a search was conducted in the PubMed, Scopus, Web of Science, Embase, and Google Scholar databases, encompassing all published data until March 2024. English-language articles detailing therapy outcomes for patients confirmed to be affected by T. indotineae, identified through molecular analysis, were included. Results: Itraconazole was shown to be a good therapeutic choice, particularly when administered at a dosage of 200 mg/day for 1–12 weeks. Voriconazole was also demonstrated to be effective, while terbinafine exhibited a reduced response rate. Griseofulvin and fluconazole, on the other hand, were found to be ineffective. Although topical treatments were mostly ineffective when used alone, they showed promising results when used in combination with systemic therapy. Mutational status was associated with different profiles of treatment response, suggesting the need for a more tailored approach. Conclusions: When managing T. indotineae infections, it is necessary to optimize therapy to mitigate resistances and relapse. Combining in vitro antifungal susceptibility testing with mutational analysis could be a promising strategy in refining treatment selection.

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