Extensive Dermatophytosis Caused by Terbinafine-Resistant <i>Trichophyton indotineae</i>, France

Abstract

I n recent years, dermatologists in India have alerted the medical community to the wide spread of recalcitrant extensive dermatophytosis across the country. Clinically, extensive dermatophytosis is characterized by tinea cruris, tinea corporis, or both, of the glabrous skin (1). The spread of this condition is thought to be a consequence of ill-advised use of over-the-counter corticosteroid-antifungal combinations, resulting in the emergence of terbinafi ne-resistant Trichophyton strains in India (2). T. mentagrophytes and T. interdigitale were suspected, but the correct identity of the etiologic agent of this outbreak was debated Genomic data showed that India terbinafi ne-resistant isolates form a distinct clade from T. interdigitale and T. mentagrophytes (5). Recently, the clinical, mycological, and molecular features of 2 highly resistant T. interdigitale isolates from patients from Nepal and India, harboring mutations in the squalene epoxidase (SQLE) gene, have been analyzed and identifi ed as a new species named T. indotineae (6).