Breaking the Treatment Barrier in Trichophyton Indotineae and Related Species: A Systematic Review of Case Reports and Case Series Publisher Pubmed



Rafat Z ; Haghighat F ; Ghazi Mirsaid R ; Salehi S ; Mahmoodi H R ; Eslami M ; Kamali Sarvestani H
Source: Microbial Pathogenesis Published:2026

Abstract

Background and aims: Dermatophytosis is one of the most common skin fungal infections worldwide. In recent years, the emergence of antifungal-resistant dermatophytes, particularly Trichophyton indotineae, has raised significant clinical and public health concerns. This systematic review aims to summarize the current evidence on infections caused by T. indotineae and related species by examining their clinical features, mechanisms of antifungal resistance, epidemiology, and diagnostic methods. Methods: This systematic review, carried out in accordance with PRISMA guidelines, examined the available evidence on infections caused by T. indotineae and related species up to July 2025. A comprehensive search was performed across major databases, including PubMed, Embase, Scopus, Web of Science, and Google Scholar. Only case reports and case series published in English were considered eligible. Data were systematically extracted using a standardized checklist in Excel. Results: This review analyzed 132 reported cases of dermatophytosis caused by T. indotineae and related species, with the majority of cases reported after 2020. T. indotineae accounted for 80.3% of identified isolates, predominantly affecting young and middle-aged adults. Male patients (n = 61, 47.6%) were more frequently affected than females. Clinically, tinea corporis (n = 70) and tinea cruris (n = 53) were the most frequent manifestations, and extensive or multifocal disease was observed in 43.8 % of patients. Clinical non-response to oral terbinafine was documented in 62.5 % of cases, while 25 patients exhibited resistance to multiple antifungal agents. SQLE mutations were identified in 57 isolates, corresponding to 83.82 % of the sequenced isolates (n = 68), and itraconazole emerged as the most commonly used alternative systemic therapy (43.29%). Discussion: The findings of this review emphasize that antifungal-resistant dermatophytosis is an emerging global challenge rather than a geographically restricted phenomenon. The proportion of by T. indotineae and related species within included studies underscore its enhanced transmissibility and therapeutic challenge. The high rate of terbinafine resistance, largely driven by SQLE gene mutations, challenges current treatment paradigms and highlights the need for early recognition and target therapy. Strengthening molecular diagnostic capacity and promoting antifungal management are essential to mitigate further spread and improve clinical outcomes. © 2026 Published by Elsevier Ltd.