Antifungal Resistance in Dermatophytosis: An Emerging Concern in IndiaIndurkar VA1

Abstract

Dermatophytosis is a superficial fungal infection involving keratinized tissues such as skin, hair, and nails, mainly caused by species of Trichophyton, Microsporum, and Epidermophyton. India has recently experienced an epidemic-like rise in chronic, recurrent, and treatment-resistant dermatophytosis. Contributing factors include hot and humid climate, overcrowding, poor hygiene, excessive sweating, and irrational use of topical corticosteroid-containing creams. The emergence of terbinafine-resistant strains, particularly Trichophyton indotineae, has significantly complicated disease management and altered the epidemiology of dermatophytosis.

This review summarizes the epidemiology, etiological agents, mechanisms of antifungal resistance, diagnostic challenges, and current management strategies of resistant dermatophytosis in India. A comprehensive literature search was conducted using PubMed, Scopus, MEDLINE, and Google Scholar databases for English-language articles published between 2015 and 2026.

Mutations in the squalene epoxidase (SQLE) gene are considered the major mechanism responsible for terbinafine resistance. Additional factors such as self-medication, poor treatment adherence, reinfection, and inadequate hygiene practices further contribute to resistance and recurrence. Resistant dermatophytosis is associated with chronic disease, psychosocial stress, and increased economic burden. Early diagnosis, rational antifungal therapy, patient education, avoidance of steroid misuse, and implementation of antifungal stewardship programs are essential for effective disease control and prevention of further resistance.