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We describe 157 cases of Trichophyton indotineae infection in the United Kingdom, mostly in patients linked to southern Asia. T. indotineae is spreading in the United Kingdom and accounts for 38% of dermatophyte isolates referred to the UK National Mycology Reference Laboratory. Clinicians should suspect T. indotineae in tinea corporis cases.

Trichophyton rubrum is the primary causative pathogen of onychomycosis, and terbinafine remains the first-line treatment for both oral and topical therapy. However, increasing reports of terbinafine resistance-associated mutations in T. rubrum from India, Europe, and other parts of Asia have raised global concern. This study aimed to investigate mutations in the squalene epoxidase ( SQLE ) gene in T. rubrum from onychomycosis samples in South Korea. Between August 2021 and November 2023, toenail specimens from patients with KOH-positive fungal microscopy were collected from six hospitals. Fungal species were identified through internal transcribed spacer (ITS) sequencing, and mutations in the squalene epoxidase ( SQLE ) gene were analyzed. Among 388 clinical samples, 231 (59.5%) were ITS PCR-positive. Sanger sequencing identified T. rubrum in 185 samples (80.5%), followed by Candida parapsilosis (7), T. mentagrophytes (4), T. violaceum (2), and various other fungi (24). Among 106 SQLE -positive T. rubrum clinical samples, 3.8% (4/106) harbored resistance-associated mutations, including Phe397Leu ( n  = 3) and Leu393Phe ( n  = 1), while the remaining 102 samples showed wild-type SQLE sequences at these positions. These findings demonstrate the presence of SQLE mutations in T. rubrum from onychomycosis samples in South Korea. Further studies incorporating fungal isolation and antifungal susceptibility testing are needed to determine their clinical significance.

Trichophyton indotineae , first identified in India, has increasingly been reported in Asia, the Middle East, Europe, and recently in the USA. The global spread of terbinafine-resistant T. indotineae underscores the urgency of the issue. With its ability for human-to-human transmission, it can be considered anthropophilic. However, its highly virulent nature suggests a possible link to zoophilic species, raising the potential for disease transmission from animals. In this study, we have performed whole genome sequencing (WGS) of terbinafine susceptible and resistant Trichophyton species from animal and human origin to understand transmission dynamics of this species. Thirteen isolates of Trichophyton spp. from human (n = 9) and canine (n = 4) origin, respectively from Chandigarh and Bareilly, India, were included in this study. Isolate identification based on ITS extracted from WGS data identified six T. indotineae ( ITS genotype VIII) and seven T. interdigitale ( ITS genotype II) isolates. WGS single nucleotide polymorhpism (SNP) analysis separated the isolates into two distinct groups, T. indotineae and T. interdigitale and showed the clonal nature of both species. For both species, low SNP differences between isolates from humans and dogs were observed as well as low differences between isolates from Chandigarh and Bareilly, cities >350 km apart from each other. These findings suggest zoonotic transmission, next to fast spread across large distances. The T. indotineae terbinafine-resistant strains exhibited the SQLE F397L substitution while susceptible strains had the SQLE S395P substitution or demonstrated a wild-type (WT) SQLE sequence. However, all T. interdigitale strains displayed a WT SQLE sequence despite terbinafine minimum inhibitory concentrations (MICs) ranging between 0.031 to 64 µg/mL.

We report an extensive, terbinafine-resistant (squalene epoxidase F397L mutation) Trichophyton indotineae infection in a previously healthy businessman from São Paulo, Brazil. The patient had previously traveled to France, Spain, and the United States. Clinician awareness, laboratory testing capacity, and surveillance are essential to prevent T. indotineae spread and inform healthcare practices.

Dermatophytoses are fungal infections of the skin, hair, and nails that affect approximately 25% of the global population. Occlusive clothing, living in a hot humid environment, poor hygiene, proximity to animals, and crowded living conditions are important risk factors. Dermatophyte infections are named for the anatomic area they infect, and include tinea corporis, cruris, capitis, barbae, faciei, pedis, and manuum. Tinea incognito describes steroid-modified tinea. In some patients, especially those who are immunosuppressed or who have a history of corticosteroid use, dermatophyte infections may spread to involve extensive skin areas, and, in rare cases, may extend to the dermis and hair follicle. Over the past decade, dermatophytoses cases not responding to standard of care therapy have been increasingly reported. These cases are especially prevalent in the Indian subcontinent, and Trichophyton indotineae has been identified as the causative species, generating concern regarding resistance to available antifungal therapies. Antifungal-resistant dermatophyte infections have been recently recognized in the United States. Antifungal resistance is now a global health concern. When feasible, mycological confirmation before starting treatment is considered best practice. To curb antifungal-resistant infections, it is necessary for physicians to maintain a high index of suspicion for resistant dermatophyte infections coupled with antifungal stewardship efforts. Furthermore, by forging partnerships with federal agencies, state and local public health agencies, professional societies, and academic institutions, dermatologists can lead efforts to prevent the spread of antifungal-resistant dermatophytes.

Trichophyton indotineae is an emerging dermatophyte frequently associated with terbinafine resistance. We report a case of recalcitrant T. indotineae infection in Singapore with limited response despite prolonged azole therapy, which only resolved after combination therapy with anidulafungin and itraconazole. This case highlights therapeutic challenges and need for improved diagnostics in T. indotineae infections.

Azole resistance in dermatophytes, particularly Trichophyton indotineae, has become a growing global concern. Current antifungal susceptibility testing protocols (EUCAST, CLSI) have limitations in reproducibility and sensitivity. This study aimed to evaluate how medium composition, incubation temperature, and spore concentration influence itraconazole susceptibility testing across various dermatophyte species. Thirty-eight clinical isolates representing Trichophyton, Microsporum, and Epidermophyton species were tested using a microplate laser nephelometry system (MLN). IC50 values for itraconazole were determined in three different media (Sabouraud glucose (SG), RPMI-based (RG), and RG supplemented with casein (RGC)) at 28 °C and 34 °C. Effects of spore concentration on growth dynamics and lag phase were also analyzed. SG medium provided clear phenotypic separation between resistant and sensitive isolates. In contrast, RG and RGC showed overlapping IC50 values. Lower spore concentrations revealed underlying growth differences, which were masked at higher inoculum levels. Temperature and media composition significantly affected IC50 outcomes. Genotypic analysis confirmed resistance-associated Erg11B point mutations and genomic amplifications in T. indotineae, particularly in combination with Erg1 mutations, forming distinct subpopulations. SG medium combined with reduced spore concentrations offered improved differentiation of resistant versus sensitive strains. These findings support the development of more accurate susceptibility testing protocols and highlight the need to establish species-specific ECOFF values for dermatophytes.

The emergence and spread of antifungal-resistant pose an increasing public health concern worldwide. Multidrug-resistant infections have been reported in China in the past few years. To understand the genetic relationship and the origin of these Chinese isolates, as well as their relationship to the global collections, we sequenced the whole genomes of 31 isolates using the Illumina platforms. Genomic epidemiology was performed on a dataset of 181 isolates from China and 8 other countries, representing the largest genome-wide analysis. Single nucleotide polymorphism analysis revealed that can be divided into four distinct phylogenetic groups (I, II, III, IV), with regional clonal transmission clusters identified in eastern China; was introduced into China more than once given the genetic variability. The isolates from South Asia may be the source of Chinese isolates based on epidemiological information. There were differences in the prevalence and resistance profiles among four phylogenetic groups, with Group III being predominant and exhibiting a higher terbinafine resistance rate of 88.24% and azole resistance. Also, we characterized the role of gene mutation, copy number variation, and gene expression in antifungal drug resistance. Terbinafine resistance could be mainly associated with Phe397Leu substitution in , and azole resistance might be related to increased copy number of , as well as elevated and expression. Given the clinical challenges posed by , this emerging dermatophyte should be recognized as a global threat, necessitating urgent collaborative surveillance and management strategies.

Objective To compare the efficacy and safety of terbinafine with griseofulvin in the treatment of tinea capitis in Western China. Methods Children (2–14 years of age) with clinically diagnosed and potassium hydroxide microscopy–confirmed tinea capitis were randomized into three groups: group GRI4 received 4 weeks of griseofulvin; group TBF2 received 2 weeks of terbinafine; and Group TBF4 received 4 weeks of terbinafine. Clinical and mycological evaluations were done in 0, 2, 4, and 8 weeks and 1 year after therapy started. The isolated pathogenic fungi were evaluated for in vitro susceptibility by detecting the minimal inhibitory concentration (MIC) against terbinafine, griseofulvin, itraconazole, and ketoconazole. Results The clinical effectiveness rate of GRI4, TBF2, and TBF4 were 100% (95% CI-confidence interval: 82–100%), 96.3% (95% CI: 81–100%), and 100%(95% CI: 85–100%), respectively, at week 8 and 100% after 1 year for the 3 groups; clinical cure rates were 84.2%(95% CI: 77–99%), 85.2%(95% CI: 71–98%), and 78.3%(95% CI: 61–95%), respectively, at week 8 and 100% after 1 year for all agents; mycological cure rates were 100%(95% CI: 74–100%), 95.0%(95% CI: 74–100%), and 94.1%(95% CI: 50–93%) at week 8 and 100% after 1 year for the 3 groups. In vitro, all patient-derived cultures were sensitive to the four antifungal agents. Conclusion Data from the clinical trial and in vitro antifungal activity indicated that terbinafine is efficacious and well tolerated in the treatment for Trichophyton infections ( T. violaceum ; Arthroderma vanbreuseghemii ; and T. tonsurans ) of the scalp, i.e., a 2- to 4-week course of terbinafine is as effective as a 4-week course of griseofulvin; in fact, a 2-week course of terbinafine is sufficient. Terbinafine is an effective alternative to griseofulvin against tinea capitis of Trichophyton infections.

Trichophyton rubrum , a dermatophyte, demonstrates a notable ability to form mature biofilms on skin and associated surfaces, strengthening its resistance to antifungal agents. This characteristic poses intricate challenges in dermatological research and therapeutic strategies, underscoring the need for innovative approaches to effectively manage fungal infections. This work assessed the impact of the anti-biofilm enzymes, i.e., cellulase, protease, and amylase, individually and in combination, on the eradication and inhibition of T. rubrum biofilm. After 168 hours of incubation, T. rubrum biofilm formation matured, and the anti-biofilm enzymes significantly reduced the rate of biofilm development. The rates of biofilm inhibition and eradication for cellulase, protease, and amylase were 64%, 38%, and 28% at 72 hours of incubation, and 47%, 25.87%, and 17%, respectively, at 168 hours. However, the combined anti-biofilm enzymes (cellulase, protease, and amylase) had a 60.62% biofilm suppression rate. SEM analysis revealed marked reductions in T. rubrum conidial density, disrupted hyphal structures, and diminished biofilm adherence in enzyme-treated samples compared to untreated controls, visually supporting the inhibitory effect observed in quantitative assays. These morphological alterations indicate compromised fungal viability and structural disintegration of the biofilm matrix. Collectively, the SEM findings reinforce the therapeutic potential of enzyme-based strategies against dermatophytic biofilms. Additionally, these anti-biofilm enzymes have shown strong efficacy in reducing the exopolysaccharide (EPS) content and degrading the complex EPS matrix network. The T. rubrum biofilm treated with anti-biofilm enzymes, such as cellulase and protease, resulted in EPS degradation by FTIR analysis. The antibiofilm enzyme cellulase showed notable degradation of the beta 1–4 linkage within the glycosidic bond. A significant degradation is observed when T. rubrum biofilm is treated with combined enzymes (cellulase, protease, and amylase). The combined enzymatic treatment disrupted the EPS matrix, indicating its potential as an effective strategy for inhibiting biofilm formation by T. rubrum.