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Luliconazole is a novel imidazole derivative, which has demonstrated in vitro efficacy against dermatophytes and Candida. The results from Phase III trials show that luliconazole 1% cream applied once daily for 2 weeks successfully resolved the clinical signs and symptoms as well as eradicated the pathologic fungi, which cause tinea pedis. A 1-week treatment with luliconazole 1% cream also produced favorable clinical and mycological results in clinical trials for tinea corporis and tinea cruris. Across trials, adverse events consisted mainly of localized reactions following application. The development of a new antifungal agent is timely due to mounting resistance among existing treatments. Because luliconazole requires a short duration of treatment, it may assist in reducing disease recurrence as a result of patient nonadherence.

Background: Tinea or dermatophytosis is a fungal infection that commonly affects stratum corneum of the skin and its other appendages. Topical antifungal agents are the first-line treatment choice for dermatophytosis among them terbinafine, luliconazole, amorolfine, and sertaconazole are more effective. Aim and Objective: The aim of the study was to assess the efficacy and safety of topical luliconazole with topical terbinafine in tinea corporis and tinea cruris management. Materials and Methods: Study conducted on 180 cases diagnosed clinically and confirmed mycologically with tinea cruris and tinea corpis between age group of 21 and 60 years were recruited. Study consists of two groups, that is, Group 1 administered with 1% terbinafine and Group 2 with 1% luliconazole. Clinical signs such as pruritus, erythema, scaling and mycological culture, and KOH mount were assessed at the beginning, end of 1st, 2nd, and 4th weeks. Results: The comparison of mean pruritus score at the beginning, at the end of 1st week and 2nd week was statistically significant (P < 0.05). The mean erythema score was statistically significant between two study groups from the beginning to the 4th week. The reduction of mean scaling score was statistically significant at the end of 1st week. The KOH values between two study groups showed significant difference at the end of the 1st week (P = 0.028). Conclusion: The status of clinical signs, mycological culture, and KOH values was better in Group 1 than Group 2. Hence, 1% luliconazole is more efficacious than 1% terbinafine in the management of tinea corporis and tinea cruris for 2 weeks. [Natl J Physiol Pharm Pharmacol 2020; 10(12.000): 1114-1117]

In this report, we describe the first isolation of two highly terbinafine (TRF)-resistant Trichophyton interdigitale -like strains from a Nepali patient and an Indian patient with tinea corporis in Japan. These strains (designated NUBS19006 and NUBS19007) exhibited a TRF minimal inhibitory concentration (MIC) of > 32 mg/L and contained a missense mutation (Phe397Leu) in squalene epoxidase ( SQLE ) gene. The internal transcribed spacer (ITS) region sequences amplified from the isolates (NUBS19006 and NUBS19007) were 99.5% identical to Japanese isolates of T. interdigitale and T. interdigitale strain CBS 428.63. The homology of region sequences were also 97.6% identical to T. mentagrophytes strain CBS 318.56. Moreover, the ITS sequences amplified from the isolates were 100% identical to highly TRF-resistant strains of T. interdigitale , which were isolated in Delhi, India, and harbored mutations in SQLE . The urease test on Christensen’s urease agar was positive for T. mentagrophytes and T. interdigitale after 7 days of incubation. On the other hand, the type strain of T. rubrum CBS 100081  T and highly TRF-resistant strains (NUBS19006 and NUBS19007) were negative on Christensen urease agar after 7 and 14 days of incubation. Moreover, NUBS19006 and NUBS19007 were also negative reaction on the hair perforation test. To avoid confusion in the taxonomy of the T. mentagrophytes / T. interdigitale complex, we suggest that the highly TRF-resistant Indian strains be considered a new species independent of T. interdigitale , according to clinical and mycological features.

Trichophyton (T.) indotineae is a newly identified dermatophyte species that has been found in a near-epidemic form on the Indian subcontinent. There is evidence of its spread from the Indian subcontinent to a number of countries worldwide. The fungus is identical to genotype VIII within the T. mentagrophytes/T. interdigitale species complex, which was described in 2019 by sequencing the Internal Transcribed Spacer (ITS) region of ribosomal DNA of the dermatophyte. More than 10 ITS genotypes of T. interdigitale and T. mentagrophytes can now be identified. T. indotineae causes inflammatory and itchy, often widespread, dermatophytosis affecting the groins, gluteal region, trunk, and face. Patients of all ages and genders are affected. The new species has largely displaced other previously prevalent dermatophytes on the Indian subcontinent. T. indotineae has become a problematic dermatophyte due to its predominantly in vitro genetic resistance to terbinafine owing to point mutations of the squalene epoxidase gene. It also displays in vivo resistance to terbinafine. The most efficacious drug currently available for this terbinafine-resistant dermatophytoses, based on sound evidence, is itraconazole.

The whole genome sequencing analysis of 20 T. indotineae strains demonstrate that this new species is distinct clonal offshoot of T. mentagrophytes/T. interdigitale spp. complex. [...]naming of this emerging antifungal-resistant species was essential as it could not be unambiguously identified as either T. mentagrophytes or T. interdigitale based on ITS sequencing, mycological and physiological characteristics. [...]in the last 5 years before labelling T. indotineae as a species de novo, studies based on rDNA ITS region sequencing identified Indian Trichophyton strains as T. mentagrophytes/interdigitale; further, Nenoff and colleagues grouped the strains as T. mentagrophytes Type VIII [3,4,6,26,32]. The BLAST searches of ITS sequences of T. indotineae on NCBI database still show ≥99% sequence similarity with T. mentagrophytes, T. interdigitale, and T. indotineae. [...]to obtain accurate identification (i.e., sequence similarity of 100% with T. indotineae), ITS sequences of well-defined reference strains described by Tang and colleagues [30], importantly, primary T. indotineae strains (NUBS19006 and NUBS19007), should be included in the analysis. Notably, TRB-resistant T. indotineae strains isolated from cases in Germany, Denmark, and Switzerland during 2016 to 2020 exhibited Phe397Leu and Leu393Phe amino acid substitutions that confer resistance to TRB [11,15,22,33]. Since 2018, several cases of clinically resistant tinea corporis with extensive lesions that do not respond to TRB have been reported from France [13,14].

We describe 7 cases of extensive tinea corporis since 2018 in a hospital in Paris, France, after failure to cure with terbinafine. Molecular analysis indicated Trichophyton mentagrophytes internal transcribed spacer type VIII (T. indotineae). This strain, which has mutations in the squalene epoxidase gene, is spreading on the Indian subcontinent.

Dermatophyte infections, also known as tinea, along with viral warts, are common skin conditions that can be difficult to treat, especially when they recur or resist standard therapies. Isotretinoin, a medication traditionally used for acne, has recently shown promise as an adjuvant therapy for these conditions. This retrospective case-series study included four adult patients with persistent or recurrent tinea infections (tinea cruris and tinea corporis) or viral warts (genital and facial) who were treated with oral isotretinoin in addition to standard therapies. The patients’ demographics, clinical presentations, treatment regimens, and responses were analyzed. All four patients showed significant clinical improvement after starting isotretinoin. Two patients with viral warts achieved complete clearance, and two patients with tinea infections experienced notable improvement. No severe side effects were reported. This case series suggests that isotretinoin may be a promising adjunctive therapy for patients with persistent or recurrent tinea infections and viral warts. However, further quantitative controlled studies are needed to confirm these findings and establish optimal treatment protocols. This study provides preliminary evidence for the potential benefit of using isotretinoin as an adjunctive therapy for recalcitrant tinea infections and viral warts. Further research is warranted to explore its efficacy and safety in larger populations.

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.

[...]this study was undertaken to compare two antifungals, conventional clotrimazole and the newer sertaconazole for the treatment of tinea corporis/cruris. At screening, the eligibility criteria for inclusion in the study were patients of both genders in age group of 18-65 years with clinical manifestations of cutaneous mycoses (tinea corporis/cruris) and confirmation done with skin scraping positive for potassium hydroxide (KOH) mount. Exclusion criteria of the study were pregnant and lactating mothers, patients with a known history of severe cardiac, pulmonary, gastrointestinal, renal, hepatic, neurological and uncontrolled diabetes mellitus, those with history of hypersensitivity to azole drugs or vehicle ingredients, previous treatment with antifungal, antibiotic or immunosuppresent agents, patients with contact dermatitis, atopic dermatitis, psoriasis or any other disease and those with superficial which are extensive and treatment resistant cases. [...]both the study medications have shown comparable efficacy and safety at the end of 4th week. [...]sertaconazole 2% cream can be chosen as a first-line agent followed by clotrimazole 2% cream.

A variety of oral and topical antifungal agents are available for the treatment of superficial fungal infections caused by dermatophytes. This review builds on the antifungal therapy update published in this journal for the first special issue on Dermatophytosis (Gupta and Cooper 2008;166:353–67). Since 2008, there have not been additions to the oral antifungal armamentarium, with terbinafine, itraconazole, and fluconazole still in widespread use, albeit for generally more severe or recalcitrant infections. Griseofulvin is used in the treatment of tinea capitis. Oral ketoconazole has fallen out of favor in many jurisdictions due to risks of hepatotoxicity. Topical antifungals, applied once or twice daily, are the primary treatment for tinea pedis, tinea corporis/tinea cruris, and mild cases of tinea unguium. Newer topical antifungal agents introduced include the azoles, efinaconazole, luliconazole, and sertaconazole, and the oxaborole, tavaborole. Research is focused on developing formulations of existing topical antifungals that utilize novel delivery systems in order to enhance treatment efficacy and compliance.