Trichophyton indotineae

A notable characteristic of T. indotineae is its reduced susceptibility to common antifungal treatments, particularly terbinafine, which has traditionally been a first-line oral therapy for dermatophyte infections. However, this resistance is not observed in all strains; some studies have reported up to 85% of isolates^[9] exhibiting resistance. This decreased efficacy is often associated with mutations in the squalene epoxidase gene.^[10]

Alternative treatments, such as itraconazole administered at high dose for several weeks, have shown efficacy. Voriconazole has also been effective, while fluconazole is generally ineffective. Topical treatments alone are often insufficient but may be beneficial when combined with systemic therapy.^[11]

While initially prevalent in South Asia,^[12][6] cases of T. indotineae infections have been reported globally, including in North America^[13][14] and Europe.^{[15][16][8][17][18]} The global spread is concerning, especially given the challenges associated with treatment-resistant strains.