Case: Dermatophyte fungus infection
This man has developed a rash on his shoulder. He has similar lesions on his trunk. He has recently travelled to India. A presumed diagnosis of tinea corporis was made, and he was given oral terbinafine. It has persisted despite 4 weeks of therapy.
What is the likely diagnosis?
The annular scaly lesion is dermatophyte fungus infection until proved otherwise.
Both direct and cultural mycology was positive.
How do you explain the response to therapy?
In the last few years, there have been reports of terbinafine resistant dermatophyte infections due to a fungus called Trichophyton indotineae, or type VII trichophyton mentagrophytes. This is an anthropophilic fungus, and is prevalent in Bangladesh, Pakistan and India, but is spreading rapidly globally. It may be due to the use of combination topical azole or allylamine steroid combination products. Infections may become very widespread.
There may also be a poor response to azoles such as itraconazole and even griseofulvin. Up to 4 weeks of oral itraconazole may be required to effect resolution.
For more information on this, see Antifungal drug resistance
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