The epidemic of recalcitrant, chronic dermatophytosis in India over the past decade is primarily attributed to which factor?
- A Emergence of a new dermatophyte species resistant to all antifungals
- B Increased immigration of patients with tinea from endemic tropical regions
- C Climate change increasing humidity and dermatophyte transmission
- D Widespread misuse of topical corticosteroid-antifungal combination creams leading to T. indotineae with terbinafine resistance ✓
Explanation
The epidemic of recalcitrant tinea corporis/cruris in India is driven by Trichophyton indotineae (previously known as T. mentagrophytes ITS genotype VIII), a newly described species with intrinsic and acquired resistance to terbinafine (due to SQLE gene mutations — squalene epoxidase). This has been driven by the widespread over-the-counter misuse of potent topical corticosteroid-antifungal combination creams (triamcinolone + clotrimazole) that suppress immune response while allowing fungal proliferation and selecting for resistance. Itraconazole remains effective; NF-UVA and oral itraconazole are current treatment strategies.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.