UNASSIGNED: There is an increasing number of reports of Trichophyton indotineae infections. This species is usually poorly responsive to terbinafine.
UNASSIGNED: A literature search was conducted in May 2024. T. indotineae infections detected outside the Indian subcontinent are generally associated with international travel. Reports of local spread are mounting.As a newly identified dermatophyte species closely related to the T. mentagrophytes complex with limited genetic and phenotypic differences, there is an unmet need to develop molecular diagnosis for T. indotineae. Terbinafine has become less effective as a first-line agent attributed to mutations in the squalene epoxidase gene (Leu393Phe, Phe397Leu). Alternative therapies include itraconazole for a longer time-period or a higher dose (200 mg/day or higher). Generally, fluconazole and griseofulvin are not effective. In some cases, especially when the area of involvement is relatively small, topical non-allylamine antifungals may be an option either as monotherapy or in combination with oral therapy. In instances when the patient relapses after apparent clinical cure then itraconazole may be considered. Good antifungal stewardship should be considered at all times.
UNASSIGNED: When both terbinafine and itraconazole are ineffective, options include off-label triazoles (voriconazole and posaconazole). We present four patients responding to these newer triazoles.
Ringworm (dermatophytosis, tinea) is a fungal infection of the skin, hair and nails that is commonly seen by primary and secondary healthcare providers. An estimated 20-25% of the global population is affected by this condition. In Europe and the United States, tineas are often treated empirically using over-the-counter medications, which can increase the risk of resistance development.While antifungal resistance is not a new problem, this topic has garnered the attention of physicians and researchers in recent years due to an outbreak from South Asia caused by a new pathogen known as Trichophyton indotineae. In this review, we summarize the global prevalence, diagnosis methods, antifungal resistance profile and treatment options for T. indotineae. While most cases outside of South Asia are linked to international travel, there is evidence suggesting local person-to-person transmission and transmission via animal contact. One hurdle to surveilling the spread of this pathogen is the requirement of complex molecular diagnosis, tackling this challenge will require the development of newer assays.Terbinafine, a widely available antifungal drug, is becoming less effective owing to resistance mutations of the squalene epoxidase gene. Itraconazole has shown effectiveness, especially with a higher dose and a longer treatment duration. There is a significant risk of T. indotineae infections becoming chronic with episodes of relapse. When both terbinafine and itraconazole fail, newer agents such as posaconazole and voriconazole can be considered. Combination therapy using oral and topical medications should also be considered.

BACKGROUND: Human dermatophytoses are the most widespread infections caused by fungi. These are capable of invading the keratin-containing tissues of animals. Nannizzia nana (N. nana) can cause ringworm in pigs and rarely cause infections in humans.
METHODS: We conducted a search using PUBMED for articles published from January 1, 1990 to March 31, 2022 to identify additional cases. The search terms used were \"Microsporum nanum\" and \"Nannizzia nana\".
RESULTS: After reviewing the literature, we identified a total of 16 cases of dermatophytosis due to N. nana since 1990. In most of the patients, the clinical diagnosis was tinea corporis and the most widely used antifungals were: terbinafine and griseofulvin.
CONCLUSIONS: N. nana is a dermatophyte species isolated infrequently in humans, but it represents a potential source of dermatophytosis in people who come into direct or indirect contact with animals and soil.

Keratinophilic fungi are mostly soil-inhabiting organisms with occasional infections in humans and animals. Even though most dermatophytes are host-adapted, cross-species infections are common by zoophilic and geophilic dermatophytes. N. nana is considered an etiological agent of ringworm in pigs but has also been isolated from other animals, including humans. However, it also possesses many characteristics of geophilic dermatophytes including the ability to grow in soil. N. nana produces characteristic pear-shaped macroconidia and usually exhibits an ectothrix pattern of hair infection. It has been isolated from dermatitis lesions as well as from soil. N. nana infections in pigs are not of much concern as far as economy or health is concerned. But it has been associated with onychomycosis and gonathritis in humans, which are significant in human medicine. The shift in the predominance of dermatophytes in humans and the ability to evolve into a potential tinea pathogen necessitates more understanding of the physiology and genetics of N. nana. In this review, we have attempted a detailed analysis of the studies about N. nana, emphasizing growth and cultural characters, physiology, isolation, infection in humans and animals, molecular characterization and antifungal susceptibility.

The Caatinga is an exclusively Brazilian biome where semiarid climatic conditions promote singularities in adaptive biodiversity. Many aromatic species are found in this region possessing antifungal properties, which are attributed to their essential oils. Thus, we questioned whether essential plant oils found in the Caatinga present anti-dermatophytic potential. Dermatophytes are keratinophilic fungi that cause one of the most prevalent mycoses globally, skin infections known as dermatophytoses (tineas). Here, we provide a comprehensive report of the available published information, analyzing the methods used to evaluate the antifungal activity, verifying the quality of the evidence and possible clinical applications, and discussing research trends in this area. The plants studied concentrated in the genera Croton (Euphorbiaceae), Lippia (Verbenaceae), Piper (Piperaceae), and Mentha (Lamiaceae). All of the studies used in vitro tests to analyze antifungal potential, and little evidence was ascertained concerning the mechanism of antifungal action. In addition, the essential oils also evidenced drug modifying activity of conventional antifungal drugs (Ketoconazole and Terbinafine). We believe that the anti-dermatophyte potential of plant essential oils occurring within the Caatinga is underestimated and that this review will encourage future chemical-pharmacological investigations into the plants within this biome.Key points• The essential oils from plants occurring in the Caatinga Biome present unknown anti-dermatophyte potential.• The studies against dermatophyte fungi concentrate on the families Lamiaceae and Verbenaceae.• In vitro assays were used to assess the anti-dermatophyte potential of the essential oils.

Dermatophytosis is a common cutaneous mycosis worldwide whose prevalence in Brazil is still unknown. This systematic review has estimated the burden of dermatophytoses from updated literature data reported in the general Brazilian population. We used the following databases: Web of Science, Medline/PubMed, Embase, The Cochrane Library and Scopus for studies published between 2011 and 2020. Original articles with an emphasis on prevalence data for dermatophytosis in the Brazilian population, and diagnosed by culture exam or molecular biology were eligible. We also assessed the methodological quality of the studies. A total of 24 articles met the inclusion criteria and were reviewed. The occurrence of dermatophytoses found in the studies ranged from 4-88.50 %. The pooled prevalence of dermatophytosis for the population studies was 25 % (95 % CI: 24.7-25.3 %). The size of the samples used in the studies ranged from 45 to 36 446 participants, and ages ranged up to 98 years old. The populations studied involved mostly women. The presence of tinea unguium (toenail and fingernail) and tinea pedis were the most frequent dermatophytosis, and we observed a predominance of Trichophyton rubrum, T. interdigitale and T. mentagrophytes. The studies were primarily conducted in patient groups with suspected mycoses and were not entirely representative of the general population. Yet we believe that in the future, more collaborative strategies would improve both diagnostic capacity and epidemiological methodologies, associating the prevalence of dermatophytosis with social and environmental risk factors. This review helps to better understand future epidemiological trends in Brazil and the world.

UNASSIGNED: Tinea corporis is a common fungal infection that mimics many other annular lesions. Physicians must familiarize themselves with this condition and its treatment.
UNASSIGNED: This article aimed to provide a narrative updated review on the evaluation, diagnosis, and treatment of tinea corporis.
UNASSIGNED: A PubMed search was performed with Clinical Queries using the key term \'tinea corporis.\' The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies, and reviews. The search was restricted to the English language. The information retrieved from the mentioned search was used in the compilation of the present article.
UNASSIGNED: Tinea corporis typically presents as a well-demarcated, sharply circumscribed, oval or circular, mildly erythematous, scaly patch or plaque with a raised leading edge. Mild pruritus is common. The diagnosis is often clinical but can be difficult with prior use of medications, such as calcineurin inhibitors or corticosteroids. Dermoscopy is a useful and non-invasive diagnostic tool. If necessary, the diagnosis can be confirmed by microscopic examination of potassium hydroxide wet-mount preparations of skin scrapings from the active border of the lesion. Fungal culture is the gold standard to diagnose dermatophytosis especially if the diagnosis is in doubt and results of other tests are inconclusive or the infection is widespread, severe, or resistant to treatment. The standard treatment of tinea corporis is with topical antifungals. Systemic antifungal treatment is indicated if the lesion is multiple, extensive, deep, recurrent, chronic, or unresponsive to topical antifungal treatment, or if the patient is immunodeficient.
UNASSIGNED: The diagnosis of tinea corporis is usually clinical and should pose no problem to the physician provided the lesion is typical. However, many clinical variants of tinea corporis exist, rendering the diagnosis difficult especially with prior use of medications, such as calcineurin inhibitors or corticosteroids. As such, physicians must be familiar with this condition so that an accurate diagnosis can be made and appropriate treatment initiated.

BACKGROUND: Human dermatophyte infections are one of the most common classes of infection globally, with an estimated 1.7 billion people contracting at least one infection annually. Southern African ethnic groups used multiple plants to treat dermatophytosis and to alleviate the symptoms, yet the anti-dermatophyte properties of most species remain poorly explored.
OBJECTIVE: Our study aimed to critically review the literature to document southern African plant species used to treat one or more dermatophytic infections, and to summarise scientific evaluations of these and other plant species. Our study aims to stimulate and focus future studies in this field.
METHODS: A thorough review of the ethnobotanical books, reviews and primary scientific studies were undertaken to identify southern African plants used traditionally to treat dermatophytosis, thereby identifying gaps in the research requiring further study.
RESULTS: Eighty-nine southern African plant species are recorded as traditional therapies for dermatophytosis. Scientific evaluations of 140 plant species were identified, although most of the species in those studies were selected for reasons apart from their traditional uses. None of those studies examined the mechanism of action of the plant species, and only a single study screened the extracts for toxicity.
CONCLUSIONS: Despite southern Africa having some of the longest continuous human civilisations globally, as well as unique and diverse flora, and good ethnobotanical records, the anti-dermatophyte properties of southern African medicinal plants remains relatively poorly explored. The efficacy of the majority of plants used traditionally to treat fungal skin disease are yet to be verified and substantial further research is required in this field.

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