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Dermatophytes: Update on Clinical Epidemiology and Treatment

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Abstract

Dermatophytes represent the largest and most common group of fungal infections, impacting 25% of the global population. Among them, Trichophyton rubrum has emerged as the predominant species, responsible for a range of conditions such as tinea corporis, tinea pedis, onychomycosis, tinea cruris, and tinea manuum. Although dermatophyte incidence varies geographically, there is a noticeable rise in cases caused by T. indotineae, a strain that exhibits resistance to terbinafine. In the past decade zoophilic dermatophyte T. mentagophytes genotype VII (now known as T. interdigitale) gains a growing importance, due to its increasing frequency, the severity of the clinical manifestation and mode of transmission. Tinea infections present with various clinical symptoms and can affect individuals of all ages, from tinea pedis in adults to tinea capitis in children. Among adults globally, tinea unguium (onychomycosis) is the most common form of dermatophytosis, affecting 5.5% of the general population. Tinea unguium is more frequently seen in developed countries, while tinea capitis is more common in developing nations. The COVID-19 pandemic has led to an increase in cases of tinea faciei, likely due to prolonged mask-wearing. Terbinafine remains the preferred treatment for dermatophyte infections worldwide due to its potent fungicidal properties, minimal risk of drug interactions, and fewer side effects compared to other oral antifungals. Itraconazole and terbinafine appear to be equally effective and safe for treating tinea cruris and tinea corporis. However, the rising resistance of dermatophytes to these antifungal drugs, along with frequent recurrences of dermatophytosis in certain regions, is becoming a significant public health concern.

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Fig. 1

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Abbreviations

BMI:

Body mass index

CO2 :

Carbon dioxide

DM:

Diabetes mellitus

TC:

Tinea capitis

MIC:

Minimal inhibitory concentration

SUBA:

Super bioavailability

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Authors and Affiliations

  1. Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Belgrade, Serbia

    Aleksandra Barac, Goran Stevanovic & Branko Milosevic

  2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

    Aleksandra Barac, Mihailo Stjepanovic, Goran Stevanovic & Branko Milosevic

  3. Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade, Serbia

    Mihailo Stjepanovic & Snjezana Krajisnik

  4. Department of Biomedical Sciences, University of Sassari, Sassari, Italy

    Bianca Paglietti

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Barac, A., Stjepanovic, M., Krajisnik, S. et al. Dermatophytes: Update on Clinical Epidemiology and Treatment. Mycopathologia 189, 101 (2024). https://doi.org/10.1007/s11046-024-00909-3

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