Strategies to improve the diagnosis and clinical treatment of dermatophyte infections

ABSTRACT

Introduction

Significant problems are associated with the diagnosis and treatment of dermatophyte infections, which constitute the most common fungal infections of the skin. Although this is a common problem in the community, there are no adequate guidelines for the management of all forms of dermatophyte infections. Even if dermatophytes are correctly diagnosed, they sometimes exhibit poor susceptibility to several antifungal compounds. Therefore, long-term treatment may be needed, especially in immunosuppressed patients, for whom antifungal pharmacotherapy may be inconvenient owing to allergies and undesirable drug interaction-related effects.

Areas covered

In this review article, problems related to the diagnosis and treatment of dermatophyte infections have been discussed, and suggestions to resolve these problems have been presented.

Expert opinion

Pretreatment microscopic or mycological examinations should be performed for dermatophyte infections. In treatment-refractory cases, antifungal-resistant strains should be determined using antifungal susceptibility testing or via molecular methods. Natural herbal, laser, and photodynamic treatments can be used as alternative treatments in patients who cannot tolerate topical and systemic antifungal treatments.

KEYWORDS:

• Artificial intelligence
• antifungal resistance
• dermatophyte
• dermoscopy
• diagnostic challenges
• inflammatory disease

Article highlights

• Although many antifungal drugs have been developed, tinea capitis remains an important cause of cicatricial alopecia.

• Most patients with suspected dermatophyte infection are treated without microscopic or mycological examination.

• Portable microscopes compatible with smartphones can be used by dermatologists who do not have microscopes.

• Calcofluor white can be added to KOH preparations to facilitate the visualization of fungal elements by microscopic examination.

• Dermoscopy is used not only for diagnosing tinea capitis but also for detecting vellus-type hair involvement in tinea corporis.

• Histopathological examination should be performed to detect invasive dermatophyte infections in immunosuppressed patients.

• Molecular methods should be added, as the species recognition of fungal elements cannot be determined using histopathological examination.

• The identification of dermatophyte species and enumeration of their ecological characteristics are crucial to detect the source of dermatophyte infections and to stop the chains of an infection.

• In the case of patients who do not respond to antifungal components, resistant dermatophyte species should be detected using either antifungal susceptibility tests or molecular methods.

• Home natural herbal treatments can be used in patients with side effects or those who do not want to use antifungal drugs.

• Photodynamic therapy is quite effective in the treatment of both superficial and invasive resistant dermatophyte infections.

• Lasers can be used in the treatment of patients with onychomycosis who use polypharmacy and have organ failure.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

The authors contributed substantially to the conception and design of the review article, interpreted the relevant literature, and were involved in writing the review article or revised it for intellectual content.

Additional information

Funding

This paper was not funded.