   |
|
GUEST EDITORIAL |
|
| Year : 2023 | Volume
: 68
| Issue : 5 | Page : 491 |
|
| Dermatophytosis: Newer insights |
|
|
Anupam Das
From the Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| Date of Web Publication | 31-Oct-2023 |
Correspondence Address:
Anupam Das
From the Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijd.ijd_830_23
|
|
How to cite this article:
Das A. Dermatophytosis: Newer insights. Indian J Dermatol 2023;68:491 |
Dermatophytosis has gradually evolved into one of the most difficult-to-treat conditions, and this has been attributed to a wide gamut of causes. Literature has been focusing a lot on the impact of topical steroids, combination creams, mutagenic shift towards Trichophyton indotineae,[1] resistance against terbinafine and many more facets.
Indian terbinafine-resistant strains, identified with rDNA ITS as 'genotype VIII',[2] have recently been termed T. indotineae based on clinical and mycological features. The emergence of this species has been attributed to steroid-induced suppression of local cellular immunity as well as an altered cutaneous microbiome. In the first article, the authors discuss the evolution of the current nomenclature and the clinical implications for the same. It is important to know whether these changing terminologies are just theoretical or physicians need to pay attention to microbiological scepticism.
Cutaneous microbiome and the resulting dysbiosis have garnered attention over the past few years, and a lot of dermatological conditions have been related to the same. Literature supports the contribution of dysbiosis towards the development of tinea capitis, onychomycosis and tinea pedis. In the second article of the symposium, the authors provide an elaborate review on the existing data and open a pandora's box. This is definitely one of the least discussed facets of dermatophytosis.
The epidemic-like scenario of dermatophytosis has led to a pressing demand for newer anti-fungal formulations and drugs. There is ongoing research on drugs with newer fungal targets, exploring potential anti-fungal properties of other anti-microbials, natural compounds and device-based physical treatments. The authors provide a comprehensive list of recently approved and upcoming drugs in the third article of this symposium.
The desperation to control the disease, lack of awareness and poorly regulated legislative laws controlling the approval of molecules have led to unscientific marketing gimmicks by the pharmaceutical industry, over-the-counter availability of drugs and a plethora of irrational and unscientific prescription patterns. The fourth article tries to highlight this issue and focuses on why anti-fungal stewardship is the need of the hour.[3]
The final article delves into the past and recent evidence pertaining to the use of the main systemic anti-fungals in dermatophytic infection of the glabrous skin, with a summary of the existent data. It provides a critical analysis of which molecule should be used for what duration and at what dose, and why physicians should not resort to the prescription of a combination of systemic anti-fungals.
Although dermatophytosis is not a novel disease and journals have been publishing a lot of data regarding the same,[4] this symposium tries to highlight some of the less frequently discussed areas and should be able to stimulate further research on this menace.
 References | |  |
| 1. | Uhrlaß S, Verma SB, Gräser Y, Rezaei-Matehkolaei A, Hatami M, Schaller M, et al. Trichophyton indotineae-An Emerging Pathogen Causing Recalcitrant Dermatophytoses in India and Worldwide-A Multidimensional Perspective. J Fungi (Basel). 2022;8(7):757. doi: 10.3390/jof8070757.  |
| 2. | Nenoff P, Verma SB, Vasani R, Burmester A, Hipler UC, Wittig F, Krüger C, Nenoff K, Wiegand C, Saraswat A, Madhu R, Panda S, et al. The current Indian epidemic of superficial dermatophytosis due to Trichophyton mentagrophytes-A molecular study. Mycoses. 2019;62:336-56. doi: 10.1111/myc.12878. |
| 3. | Ray A, Das A, Panda S. Antifungal stewardship: What we need to know. Indian J Dermatol Venereol Leprol 2023;89:5-11. |
| 4. | Dogra S, Ramam M. Difficult Dermatophytosis. JAMA Dermatol. 2022. doi: 10.1001/jamadermatol.2022.3736. |
|
|
|
|
|
|
|
|
|
