Dermatology: Practical and Conceptual Review | Dermatol Pract Concept. 2025;15(4):5517 1 Evaluation of Clinical Studies of Patients With Dermatophyte Infections Caused by Trichophyton indotineae: Treatment Response and Resistance to Antifungal Medications Funda Tamer1, Muhterem Polat1 1 Gazi University School of Medicine, Department of Dermatology, Ankara, Turkey Key words: Dermatophytosis, Treatment, Trichophyton indotineae Citation: Tamer F, Polat M. Evaluation of Clinical Studies of Patients With Dermatophyte Infections Caused by Trichophyton indotineae: Treatment Response and Resistance to Antifungal Medications. Dermatol Pract Concept. 2025;15(4):5517. DOI: https://doi.org/10.5826 /dpc.1504a5517 Accepted: June 5, 2025; Published: October 2025 Copyright: ©2025 Tamer et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Introduction: Dermatophytoses are the most frequent fungal infections of the skin. It has been re- ported that dermatophyte infections resistant to antifungal medications have increased in recent years. Therefore, superficial fungal skin infections that are difficult to treat have become a major health problem worldwide. Trichophyton indotineae is a newly described dermatophyte species that has been mainly isolated from patients with dermatophytosis characterized by widespread skin lesions and re- sistance to antifungal treatment and that causes outbreaks. T. indotineae leads to a pruritic rash that affects the large areas of the body surface such as the trunk, groin, and extremities, even in immuno- competent patients. Moreover, these patients usually do not respond to systemic terbinafine, which is the first-line treatment for dermatophyte infections and has fungicidal effects. Objectives: Our aim was to determine the body sites affected by T. indotineae infection, the types of tinea caused by T. indotineae, the drugs to which it is particularly resistant, and the treatment regimens to which it responds. Methods: Articles in the PubMed database published between December 2020 and September 2024 were investigated by searching the word “Trichophyton indotineae”. Results: We reviewed 39 studies in the PubMed database that reported patients with T. indotineae infection to identify treatment regimens to which it is resistant or responsive. ABSTRACT 2 Review | Dermatol Pract Concept. 2025;15(4):5517 Introduction Trichophyton indotineae is a newly described dermato- phyte species that is frequently isolated in patients with dermatophyte infections characterized by extensive skin lesions and antifungal treatment resistance [1-3]. Pa- tients are usually unresponsive to systemic terbinafine, which is the first-line treatment for dermatophyte infec- tions. In addition, topical or systemic administration of steroids due to misdiagnoses worsens T. indotineae in- fection. It has been reported that clinicians’ awareness of treatment-resistant fungal infections caused by Tricho- phyton indotineae is inadequate and needs to be increased [2]. Moreover, treatment guidelines should be established to select the appropriate alternative antifungal medi- cation and determine the adequate drug dose and dura- tion in terbinafine-resistant skin infections caused by T. indotineae. Nevertheless, the data required to develop standard treatment regimens are insufficient [4]. Objectives We evaluated articles reporting patients with dermato- phytosis caused by T. indotineae to determine the body sites affected by the infection, the types of tinea caused by Tindotineae, and, in particular, the drugs to which it is resis- tant and the treatment regimens to which it responds. Methods The articles in the PubMed database published between December 2020 and September 2024 were investigated by searching the word “Trichophyton indotineae”. After re- viewing the titles and abstracts, human studies reporting patients with dermatophytosis caused by T. indotineae were included. Articles for which the full text was not available, non-English articles, laboratory studies without patient in- volvement, reviews, meta-analyses, in vitro studies, and ani- mal studies were excluded from this review. Results The search steps are outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram (Figure 1) [5]. The initial PubMed search identified 98 articles; of these, 39 met the inclusion criteria and were further reviewed. Studies on Patients with T. indotineae Infections Original Articles Kano et al. reported two patients with tinea corporis who had traveled to Nepal and India (Table 1). The patients had previously been treated with terbinafine but had not shown any clinical response. After performing internal transcribed spacer (ITS) region sequences analysis, T. indotineae was detected in skin lesions. Both patients recovered completely with itraconazole and fosravuconazole treatment [6]. Khurana et al. reported 40 patients with tinea corporis and tinea cruris caused by T. indotineae. Among these pa- tients, 12 had previously used systemic antifungals, 24 had previously used topical antifungals, and 24 had used topical steroids. Patients were treated with itraconazole at different doses of 100 mg, 200 mg, or 400 mg daily. Complete clini- cal response was observed in 37 patients; treatment failure occurred in three patients. Khurana et al. stated that serum itraconazole levels lower than 0.2 μg/ml were associated with treatment failure, while successful treatment could be achieved with values above this level [7]. Pashootan et al. investigated the antifungal susceptibil- ity of T. indotineae detected in samples obtained from five patients with tinea cruris, three patients with tinea pedis, and two patients with tinea corporis. Among the antifun- gals such as itraconazole, terbinafine, voriconazole, keto- conazole, fluconazole, posaconazole, and amphotericin B, terbinafine was reported to have the highest effect against T. indotineae [8]. Moreno-Sabater et al. evaluated the frequency of T. indotineae as an etiological agent and terbinafine resis- tance in patients with dermatophyte infections. Among the 580 samples, terbinafine resistance was observed in three samples, and T. indotineae was detected as the causative agent in one of them. This patient reportedly had traveled to India, had been diagnosed with tinea corporis, and had been treated with itraconazole 200 mg daily. On the other hand, T. indotineae was detected in a total of six specimens. T. indotineae was particularly characterized by inflamma- tory skin lesions and was detected in patients with tinea cruris and tinea corporis. However, in two patients, it was also associated with onychomycosis of the fingernails and tinea pedis [9]. Conclusion: Treatment guidelines should be established to select the appropriate alternative anti- fungal medication and determine the adequate drug dose and duration in treatment-resistant fungal skin infections caused by T. indotineae. Nevertheless, the data required to develop standard treatment regimens are insufficient. Review | Dermatol Pract Concept. 2025;15(4):5517 3 Figure 1. The search process for the articles is stated in the flow diagram. Table 1. Articles Reporting Patients with Dermatophyte infections caused by Trichophyton indotineae. Author Infection Treatment resistance Effective treatment Treatment duration Kano et al.6 Tinea corporis Terbinafine Itraconazole, fosravuconazole Not specified Khurana et al.7 Tinea corporis, tinea cruris Systemic terbinafine, griseofulvin, itraconazole, fluconazole, topical antifungals Itraconazole Until cure Pashootan et al.8 Tinea corporis, tinea cruris, tinea pedis Not specified Not specified Not specified Moreno-Sabater et al.9 Tinea corporis, tinea cruris, tinea pedis, fingernail onychomycosis Not specified Oral itraconazole 1-3 months Astvad et al.10 Not specified Not specified Not specified Not specified Posso-De Los Rios et al.11 Tinea corporis, tinea faciei Tinea corporis Tinea corporis Tinea corporis, tinea faciei Tinea corporis Tinea corporis, tinea faciei Tinea corporis, tinea pedis Tinea corporis Oral terbinafine, fluconazole Clotrimazole cream, oral terbinafine Clotrimazole cream Terbinafine cream, ciclopirox cream, oral itraconazole Ketoconazole cream, oral fluconazole Oral terbinafine, itraconazole, topical terbinafine and ketoconazole Topical antifungal Clotrimazole cream Referred to infectious disease department Oral itraconazole Ketoconazole cream Oral fluconazole* Referred to infectious disease department Referred to infectious disease department Oral fluconazole*, topical clotrimazole Ciclopirox cream* Not specified 4 weeks Lost to follow-up 12 weeks Not specified Not specified 12 weeks Not specified Table1 continues 4 Review | Dermatol Pract Concept. 2025;15(4):5517 Author Infection Treatment resistance Effective treatment Treatment duration Jia et al.12 Tinea corporis, tinea cruris, tinea faciei Oral fluconazole, miconazole nitrate cream Oral itraconazole, bifonazole cream, ketoconazole lotion 4 weeks Bortoluzzi et al.13 Tinea corporis, tinea cruris Systemic and topical terbinafine Oral itraconazole 14 days Kong et al.14 Tinea corporis, tinea cruris Oral itraconazole, terbinafine, topical terbinafine, econazole and ketoconazole Oral itraconazole+ and topical naftifine hydrochloride/ ketoconazole Itraconazole pulse therapy 3 weeks 5 weeks Tamimi et al.15 Tinea corporis, tinea cruris Oral terbinafine, itraconazole Oral terbinafine, itraconazole, voriconazole, topical clotrimazole Not specified Caplan et al.16 Tinea corporis, tinea cruris, tinea faciei Oral terbinafine, fluconazole, griseofulvin, voriconazole, topical antifungal medication Oral fluconazole, griseofulvin, itraconazole 2 weeks-2 months Ngo et al.17 Tinea corporis, tinea cruris, tinea pedis Not specified Not specified Not specified Hiruma et al.18 Tinea corporis Not specified Not specified Not specified Dellière et al.19 Tinea corporis Tinea corporis Tinea corporis Tinea corporis, tinea faciei Tinea corporis Tinea corporis Tinea corporis Oral terbinafine, griseofulvine Oral terbinafine Oral terbinafine Oral terbinafine None None Oral terbinafine, topical bifonazole Oral itraconazole+ Oral itraconazole+ Oral itraconazole Oral itraconazole Oral terbinafine, topical ciclopirox Oral fluconazole+, topical terbinafine Oral terbinafine+ 12 weeks 12 weeks 8 weeks 12 weeks Lost to follow-up 16 weeks 8 weeks Jabet et al.20 Tinea corporis, tinea cruris None None None Terbinafine, griseofulvin, econazole Terbinafine None None None None Terbinafine, griseofulvin Oral and topical terbinafine Terbinafine Terbinafine None None Ciclopirox olamine Terbinafine, bifonazole+ Omoconazole, miconazole Terbinafine Itraconazole 1 month 1 month 2 months Lost to follow-up Lost to follow-up 1 month 6 weeks 2 months 1 month 2 months Ngo et al.21 Tinea corporis None Oral itraconazole Topical ketoconazole 1 week 2 weeks Durdu et al.22 Tinea cruris Tinea corporis Oral terbinafine, itraconazole, topical antifungals Oral and topical terbinafine, resveratrol Oral fluconazole+ Resveratrol tablet Oral itraconazole+ Oral itraconazole Not specified 4 weeks 2 months Table 1. Articles Reporting Patients with Dermatophyte infections caused by Trichophyton indotineae. (continued) Review | Dermatol Pract Concept. 2025;15(4):5517 5 Author Infection Treatment resistance Effective treatment Treatment duration Caplan et al.23 Tinea corporis, tinea cruris Tinea corporis, tinea cruris Oral terbinafine Oral terbinafine, clotrimazole and terbinafine cream Oral itraconazole Griseofulvin 4 weeks 4 weeks Russo et al.24 Tinea corporis Tinea corporis, tinea cruris Topical econazole, ketoconazole lotion None None Oral terbinafine, topical ketoconazole Lost to follow-up 4 months Dashti et al.25 Tinea corporis, tinea cruris, tinea faciei Oral terbinafine, griseofulvin, itraconazole, topical terbinafine, miconazole Oral voriconazole 3 months Messina et al.26 Tinea corporis Oral fluconazole, terbinafine, topical antifungals SUBA itraconazole 4 weeks Crotti et al.27 Tinea corporis, tinea cruris, tinea faciei, tinea manuum, onychomycosis Oral fluconazole, topical ketoconazole Oral terbinafine, topical ciclopirox nail solution 12 weeks Thakur et al.28 Tinea universalis None Oral itraconazole, topical luliconazole 2 months Pavlović et al.29 Tinea corporis, tinea cruris, tinea faciei Oral terbinafine, fluconazole, topical terbinafine Oral itraconazole 8 weeks Teo et al.30 Tinea cruris Tinea cruris Not specified Topical miconazole Not specified Oral itraconazole, topical terbinafine, ketoconazole Not specified Under follow-up Fukada et al.31 Tinea faciei Topical ketoconazole Oral itraconazole 5 weeks Spivack et al.32 Tinea genitalis Oral terbinafine, fluconazole, topical econazole and ketoconazole Oral itraconazole 8 weeks Tamimi et al.33 Tinea incognito Tinea incognito Tinea incognito Tinea incognito Terbinafine Terbinafine Terbinafine Terbinafine, topical clotrimazol Not specified Not specified Madarasingha et al.34 Extensive dermatophytosis None Oral terbinafine None Oral terbinafine None Oral itraconazole+ Oral itraconazole+ Oral itraconazole+ Oral itraconazole+ Oral itraconazole+ 6 weeks 4 weeks 8 weeks 6 weeks 10 weeks Chua et al.35 Tinea cruris Oral fluconazole, topical terbinafine, clotrimazole Oral itraconazole 8 weeks Table 1. Articles Reporting Patients with Dermatophyte infections caused by Trichophyton indotineae. (continued) Table1 continues 6 Review | Dermatol Pract Concept. 2025;15(4):5517 Author Infection Treatment resistance Effective treatment Treatment duration Smith et al.36 Tinea corporis Oral fluconazole, terbinafine, itraconazole, griseofulvin, topical terbinafine, topical ketoconazole, nystatin Not specified Not specified Mochizuki et al.37 Tinea corporis Topical luliconazole Oral itraconazole, topical lanoconazole+ 1 month Tan et al.38 Tinea cruris None Oral itraconazole, topical sertaconazole 4 weeks Carroll et al.39 Tinea cruris, tinea faciei, tinea capitis Oral terbinafine, itraconazole, topical antifungals Topical griseofulvin 6 weeks Gueneau et al.40 Tinea corporis Systemic terbinafine and griseofulvin, topical terbinafine, econazole and bifonazole Voriconazole cream 6 months Villa-Gonzalez et al.41 Tinea corporis Oral terbinafine Oral itraconazole 6 months Xie et al.42 Tinea corporis, tinea cruris, tinea faciei Oral voriconazole, terbinafine Oral itraconazole 1-8 weeks Abdolrasouli et al.43 Tinea corporis, tinea cruris Betamethasone dipropionate/ clotrimazole cream, terbinafine cream Oral itraconazole 2 months Bui et al.44 Tinea corporis, tinea cruris Oral terbinafine, griseofulvin, fluconazole, topical clotrimazole Oral itraconazole, topical ketoconazole 7 weeks SUBA: Super bioavailable. * Treatment response was still being monitored. + Relapse was observed after treatment. Table 1. Articles Reporting Patients with Dermatophyte infections caused by Trichophyton indotineae. (continued) Astvad et al. examined the susceptibility tests performed on samples taken from patients with dermatophyte infec- tion. T. indotineae was detected in six of the 59 patients. Ter- binafine resistance was observed in all specimens obtained from these patients [10]. Posso-De Los Rios et al. evaluated eight Canadian pa- tients with fungal skin infections due to T. indotineae who had traveled to India. All patients had previously used oral or topical antifungal medications without a complete clinical response. Three patients were started on oral itraconazole or fluconazole treatment, two patients were started on only topical antifungal treatment, and three patients were referred to the infectious diseases department [11]. Jia et al. reported the first case of T. indotineae- associated dermatophytosis in China. After four weeks of treatment with oral itraconazole 200 mg/day, bifonazole 1% cream twice daily, and ketoconazole 2% lotion, the lesions healed com- pletely, leaving post-inflammatory hyperpigmentation [12]. Bortoluzzi et al. investigated five patients infected with T. species who were unresponsive to terbinafine treatment. ITS region sequences analysis identified T. rubrum in one pa- tient and T. indotineae in four patients. They recovered with 14 days of oral itraconazole treatment, and the lesions did not recur during the 12-week follow-up [13]. Kong et al. described complete healing in a patient with T. indotineae infection three weeks after treatment with oral itraconazole 200 mg/day and naftifine hydrochloride/ ketoconazole cream. Nevertheless, the lesions recurred two weeks after discontinuation of the medications. The patient was initiated itraconazole pulse therapy (200 mg twice daily) for five weeks. The lesions did not recur at the 3-month follow-up [14]. Review | Dermatol Pract Concept. 2025;15(4):5517 7 patients with T. indotineae infection. As the first patient was unresponsive to oral terbinafine and itraconazole, oral fluconazole 200 mg/day treatment was started. Although the patient healed completely, the lesions recurred when itraconazole was stopped. The patient was started on res- veratrol tablet, and the lesions regressed without the need for antifungal treatment. The other patient was a female with terbinafine-resistant tinea corporis. She recovered com- pletely with oral itraconazole 200 mg/day for four weeks; however, the lesions recurred one month after the treatment was discontinued. She was started on resveratrol; however, unlike the first patient, there was no clinical response. The patient was started on oral itraconazole again, and no re- currence was observed after two months of treatment [22]. Caplan et al. reported two patients; the first was a fe- male with a terbinafine-resistant but itraconazole-sensitive T. indotineae infection that began during pregnancy. The other patient had a T. indotineae infection that started while she was in Bangladesh, and most of the lesions resolved after one month of griseofulvin treatment [23]. Russo et al. described two patients with tinea corporis and tinea cruris. The first was a breastfeeding female and was therefore able to use only topical therapy such as ke- toconazole. However, there was no response to treatment. The second patient was treated with oral terbinafine and topical ketoconazole; oral terbinafine treatment was ex- tended to four months, and a complete clinical response was achieved [24]. Dashti et al. presented a dermatology nurse with dis- seminated dermatophytosis which was unresponsive to terbinafine, griseofulvin, and itraconazole. The patient was successfully treated with oral voriconazole. Voriconazole was given at a dose of 800 mg for the first two days, then was reduced to 400 mg per day for three months [25]. Messina et al. reported rapid, complete clinical response to super bioavailable (SUBA) itraconazole treatment in a pa- tient with tinea corporis caused by T. indotineae which was unresponsive to systemic fluconazole and terbinafine treat- ment. SUBA itraconazole was preferred because it allows rapid attainment of therapeutic blood levels and was given at a dose of 50 mg twice a day for four weeks [26]. Crotti et al. reported a dermatophyte infection with skin and nail involvement due to T. indotineae in an Indian immigrant. Since the lesions were unresponsive to oral flu- conazole, the patient was initiated on oral terbinafine and ciclopirox nail solution, and the lesions regressed after 12 weeks [27]. Thakur et al. reported a disseminated derma- tophyte infection due to T. indotineae. The cure was achieved in two months with oral itraconazole 200 mg/day and topi- cal 1% luliconazole [28]. Pavlović et al. presented a case of a treatment-resistant tinea cruris associated with T. indotineae that spread to the Tamimi et al. evaluated 72 patients with tinea corpo- ris and tinea cruris; T. indotineae was the causative agent in 53 patients. Of all patients, 47 had treatment-resistant in- fection, 42 of whom were infected with T. indotineae. Thirty patients with T. indotineae infection were unresponsive to terbinafine, 20 to itraconazole, and eight to both itracon- azole and terbinafine. Refractory cases were treated with oral terbinafine, itraconazole, and voriconazole alone or in combination, with or without topical antifungal drugs such as clotrimazole [15]. Caplan et al. evaluated the characteristics of 11 patients infected with T. indotineae. All patients except two had traveled to Bangladesh. None of the patients responded to topical antifungals. Seven patients received oral terbinafine, and two received voriconazole, without a complete response. Four patients received oral fluconazole; two improved, and two were unresponsive to treatment. Of the five patients who received griseofulvin, two showed a clinical response to treatment, while three did not respond. Of the seven patients who received oral itraconazole, five responded to treatment, one was lost to follow-up, and one discontinued treatment due to side effects [16]. In a study by Ngo et al., T. indotineae was the caus- ative agent in four of 114 patients with dermatophytosis. In vitro, T. indotineae was susceptible to itraconazole and voriconazole in all patients, while resistance to terbinafine was detected in half of them [17]. Short Reports In a study by Hiruma et al., T. indotineae was detected in two patients with tinea corporis in Japan. In addition to terbinafine resistance, T. indotineae was found to be resistant to eficonazole and luliconazole [18]. Case Series Dellière et al. reported seven patients with tinea corporis who were generally started on itraconazole due to terbina- fine resistance. However, relapse was observed five months after treatment in one patient and one year after treatment in three patients [19]. Jabet et al. described 10 patients with T. indotineae infections; most were treated with oral terbin- afine. Complete clinical response was observed only in three patients; two patients did not respond to antifungal therapy. One of the patients who showed clinical improvement had a relapse, while three were lost to long-term follow-up [20]. Case Reports Ngo et al. reported a male patient with a 2-month history of tinea corporis due to T. indotineae. After one week of 200 mg/day of oral itraconazole and two weeks of topi- cal ketoconazole treatment, almost complete improvement was observed in the lesion [21]. Durdu et al. described two 8 Review | Dermatol Pract Concept. 2025;15(4):5517 another patient from Sri Lanka who had yet to commence treatment [35]. Smith et al. presented a case of tinea corpo- ris that developed after travel to India. The patient did not respond to systemic terbinafine, fluconazole, itraconazole, or griseofulvin. The lesion progressed even after increasing the dose of itraconazole to 400 mg/day [36]. Mochizuki et al. reported T. indotineae infection in a Vietnamese patient working in Japan. The patient was started on oral itraconazole 100 mg daily and lanoconazole cream and recovered completely after four weeks of treat- ment. The lesions recurred eight weeks after the cessation of medications. Therefore, the patient was started on the same treatment again [37]. Letters to the Editor Tan et al. described a female with extensive dermatophytosis who was treated with oral itraconazole and sertaconazole cream. The clinical response was good in the first month. Terbinafine-resistant T. indotineae was identified as the etio- logical agent, which also revealed low MIC levels of itracon- azole, posaconazole, and voriconazole and high MIC levels of fluconazole [38]. Carroll et al. reported T. indotineae infection in a Bangla- deshi patient residing in Ireland. The patient was unrespon- sive to itraconazole and terbinafine. Although the patient was prescribed liquid griseofulvin to be taken orally, the patient mistakenly applied griseofulvin topically to the skin lesions. Nevertheless, the patient recovered after six weeks of treatment [39]. Gueneau et al. described a patient with treatment-resistant tinea corporis who was initiated on voriconazole 1% cream once daily. The lesions regressed with six months of treat- ment; however, they recurred six months after discontinua- tion of the treatment. Voriconazole cream was restarted, and the cure was achieved after two months of treatment [40]. Villa-Gonzalez et al. presented a Bangladeshi female in Spain who developed tinea corporis unresponsive to oral terbinafine. The patient recovered completely with three months of itraconazole 200 mg/day treatment. The lesions recurred one week after the treatment was stopped. The patient was given 100 mg of itraconazole daily for three more months, and no new lesion was observed af- terwards [41]. Xie et al. described 14 patients with T. indotineae infection. Clinical and mycological cure was achieved in two patients who received oral itraconazole and topical antifun- gal medication. In addition, skin lesions improved in five patients with oral itraconazole. Recurrence was observed in two patients after itraconazole treatment. None of the seven patients who received oral terbinafine adequately responded to treatment. Two patients received oral voriconazole, but face, trunk, and extremities. Skin lesions improved in eight weeks with oral itraconazole 200 mg/day and topical clotri- mazole treatment [29]. Teo et al. investigated the antifungal resistance of T. indotineae obtained from the skin samples of two patients with tinea cruris. While no detailed clinical in- formation was given about the female patient in the study, it was stated that the male patient’s lesions recurred after top- ical miconazole treatment and that he was followed up with systemic itraconazole, topical terbinafine, and ketoconazole treatment [30]. Fukada et al. described a case of tinea faciei caused by T. indotineae that may have been facilitated by topical steroid use. Although the patient recovered completely after four weeks of treatment with oral itraconazole 100 mg/day, the lesions recurred after treatment. The infection was controlled with itraconazole 400 mg/day for another week. Fukada et al. stated that T. indotineae was not a terbinafine-resistant strain. Although the minimal inhibitory concentration (MIC) for terbinafine was low, they recommended itraconazole to the patient since the MIC does not always correlate with clinical response [31]. Spivack et al. presented a female who developed derma- tophytosis due to T. indotineae in the genital area after sex- ual intercourse with a person with similar complaints. The patient had not responded to multiple systemic and topical antifungal treatments. Moreover, the topical steroids she had used with the misdiagnosis of dermatitis exacerbated the le- sions. The patient transmitted the disease to her new partner after sexual intercourse. She was started itraconazole at a dose of 400 mg/day. After eight weeks of treatment, skin le- sions completely regressed, and no recurrence was observed [32]. Tamimi et al. presented four females with tinea incog- nito who were misdiagnosed as having dermatitis and had used topical steroids. The causative agent was T. indotin- eae and showed resistance to terbinafine both in vivo and in vitro [33]. Madarasingha et al. presented five patients with exten- sive dermatophyte infection caused by T. indotineae; two pa- tients were started on oral terbinafine. However, they were switched to itraconazole due to inadequate response. The remaining patients were treated with itraconazole; however, they still required systemic antifungal therapy for up to 10 weeks. However, relapse was observed in all patients. Terbi- nafine and fluconazole resistance was detected in skin sam- ples obtained from all patients, whereas the MIC value for itraconazole was low except for one patient [34]. Chua et al. reported treatment-resistant tinea cruris in an Afghan patient living in Australia. T. indotineae was detected by ITS region sequences analysis, and antifungal susceptibil- ity test revealed low MIC levels for itraconazole. The patient responded to eight weeks of oral itraconazole treatment. The authors also noted that they had detected T. indotineae in Review | Dermatol Pract Concept. 2025;15(4):5517 9 be resistant to terbinafine treatment, cases that respond to oral terbinafine have also been revealed. Further comprehen- sive clinical studies are required to determine the appropriate antifungal medications as the first-line treatment and treat- ment steps for superficial fungal skin infections caused by T. indotineae as well as the effective dose and duration of the treatment and the sufficient follow-up time to establish treatment guidelines. References 1. Liang G, Li X, Li R, et al. Chinese expert consensus on man- agement of antifungal-resistant dermatophytoses (2024 edi- tion). Mycoses. 2024;67(9):e13785. DOI: 10.1111/myc.13785. PMID: 39245647. 2. Gold JAW, Benedict K, Lockhart SR, et al. Recognition of antifungal-resistant dermatophytosis by infectious diseases specialists, United States. Emerg Infect Dis. 2024;30(9):1978- 1980. DOI: 10.3201/eid3009.240118. PMID: 39174019. 3. Uhrlaß S, Verma SB, Gräser Y, et al. Trichophyton indotineae-an emerging pathogen causing recalcitrant dermatophytoses in India and worldwide-a multidimensional perspective. J Fungi (Basel). 2022;8(7):757. DOI: 10.3390/jof8070757. PMID: 35887512. 4. Ferreira CB, Lisboa C. A systematic review on the emergence of terbinafine-resistant Trichophyton indotineae in Europe: time to act? J Eur Acad Dermatol Venereol. 2024. Published online. DOI: 10.1111/jdv.20270. PMID: 39082800. 5. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. DOI: 10.1136/bmj.n71. PMID: 33782057. 6. Kano R, Kimura U, Kakurai M, et al. Trichophyton indotineae sp. nov.: a new highly terbinafine-resistant anthropo- philic dermatophyte species. Mycopathologia. 2020;185(6):947- 958. DOI: 10.1007/s11046-020-00455-8. PMID: 32449054. 7. Khurana A, Agarwal A, Singh A, et al. Predicting a therapeutic cut-off serum level of itraconazole in recalcitrant tinea corporis and cruris-a prospective trial. Mycoses. 2021;64(12):1480-1488. DOI: 10.1111/myc.13367. PMID: 34532888. 8. Pashootan N, Shams-Ghahfarokhi M, Chaichi Nusrati A, Salehi Z, Asmar M, Razzaghi-Abyaneh M. Phylogeny, antifungal sus- ceptibility, and point mutations of SQLE gene in major patho- genic dermatophytes isolated from clinical dermatophytosis. Front Cell Infect Microbiol. 2022;12:851769. DOI: 10.3389 /fcimb.2022.851769. PMID: 35372131. 9. Moreno-Sabater A, Normand AC, Bidaud AL, et al. Terbinafine resistance in dermatophytes: a French multicenter prospective study. J Fungi (Basel). 2022;8(3):220. DOI: 10.3390/jof8030220. PMID: 35330222. 10. Astvad KMT, Hare RK, Jørgensen KM, Saunte DML, Thomsen PK, Arendrup MC. Increasing terbinafine resistance in danish Trichophyton isolates 2019-2020. J Fungi (Basel). 2022;8:801. DOI: 10.3390/jof8020150. PMID: 35205904. 11. Posso-De Los Rios CJ, Tadros E, Summerbell RC, Scott JA. Terbinafine resistant Trichophyton indotineae iso- lated in patients with superficial dermatophyte infection in Canadian patients. J Cutan Med Surg. 2022;26(4):371-376. DOI: 10.1177/12034754221077891. PMID: 35144480. treatment was discontinued due to poor response and side effects [42]. Abdolrasouli et al. described a patient with tinea corpo- ris who had recently traveled to Central and South America and who did not adequately respond to topical antifungal medications. However, he was successfully treated with oral itraconazole 200 mg/day for two months [43]. Bui et al. reported a case of an extensive T. indotineae infection which was unresponsive to terbinafine, griseoful- vin, and fluconazole. The patient was initially started on oral itraconazole 200 mg twice a day and topical 2% keto- conazole. After four days, the evening dose of itraconazole was adjusted to 300 mg to increase its trough level [44]. Discussion T. indotineae is a novel dermatophyte species, first described in 2020 in India. Thereafter, T. indotineae infections spread rapidly outside India and were observed throughout the world, including in Europe and North America [45, 46]. Although isolating T. indotineae and determining the anti- fungal medication to which it is sensitive is crucial for effec- tive treatment, performing laboratory tests for this purpose routinely and widely remains challenging [46]. T. indotineae is highly resistant to terbinafine, and this resistance is grad- ually increasing. Patients who are resistant to terbinafine are usually started on oral itraconazole therapy [45]. However, it has recently been shown that T. indotineae is also frequently resistant to azole antifungal drugs such as itraconazole and fluconazole [47]. On the other hand, experience in the useful- ness of combination treatments containing different systemic antifungal medications for the management of T. indotineae infections is insufficient [45]. Conclusion In the medical literature, articles on T. indotineae infection have been published from different countries all over the world. However, the number of clinical studies involving hu- man participants is limited, and they are usually in the form of case reports describing one or a few patients. Within this review, we evaluated 39 clinical studies including 12 original articles, one short report, two case series, 17 case reports, and seven letters which described patients with different types of tinea caused by T. indotineae. In these publications, the most common dermatophyte infections detected in patients were tinea corporis and tinea cruris. Besides widespread skin in- volvement, the infection was usually resistant to treatment, and some patients required receiving various topical and systemic antifungal treatments, either in combination, at increased doses, or for prolonged periods, to achieve com- plete healing. Although T. indotineae has been reported to 10 Review | Dermatol Pract Concept. 2025;15(4):5517 25. Dashti Y, Alobaid K, Al-Rashidi S, et al. Autochthonous case of Trichophyton indotineae in Kuwait. J Mycol Med. 2023;33(4):101432. DOI: 10.1016/j.mycmed.2023.101432. PMID: 37666031. 26. Messina F, Santiso G, Romero M, Bonifaz A, Fernandez M, Marin E. First case report of tinea corporis caused by Trichophy- ton indotineae in Latin America. Med Mycol Case Rep. 2023;41: 48-51. DOI: 10.1016/j.mmcr.2023.08.004. PMID: 37706043. 27. Crotti S, Cruciani D, Spina S, et al. A terbinafine sensitive Tricho- phyton indotineae strain in Italy: the first clinical case of tinea corporis and onychomycosis. J Fungi (Basel). 2023;9(9):865. DOI: 10.3390/jof9090865. PMID: 37754973. 28. Thakur R, Kushwaha P, Kalsi AS. Tinea universalis due to Trichophyton indotineae in an adult male. Indian J Med Mi- crobiol. 2023;46:100476. DOI: 10.1016/j.ijmmb.2023.100476. PMID: 37806168. 29. Pavlović MD, Marzouk S, Bećiri L. Widespread dermatophy- tosis in a healthy adolescent: the first report of multidrug- resistant Trichophyton indotineae infection in the UAE. Acta Dermatovenerol Alp Pannonica Adriat. 2024;33(1):53-55. DOI: 10.15570/actaapa.2024.4. PMID: 38347717. 30. Teo JWP, Cheng JWS, Chew KL, Lin RTP. Whole genome charac- terization of Trichophyton indotineae isolated in Singapore. Med Mycol. 2024;62(2):myae012. DOI: 10.1093/mmy/myae012. PMID: 38366631. 31. Fukada N, Kobayashi H, Nakazono M, et al. A case of tinea fa- ciei due to Trichophyton indotineae with steroid rosacea related to topical over-the-counter drugs purchased outside of Japan. Med Mycol J. 2024;65(1):23-26. DOI: 10.3314/mmj.23-00014. PMID: 38417884. 32. Spivack S, Gold JAW, Lockhart SR, et al. Potential sexual trans- mission of antifungal-resistant Trichophyton indotineae. Emerg Infect Dis. 2024;30(4):807-809. DOI: 10.3201/eid3004.240115. PMID: 38437706. 33. Tamimi P, Fattahi M, Ghaderi A, et al. Terbinafine-resistant T. indotineae due to F397L/L393S or F397L/L393F mutation among corticoid-related tinea incognita patients. J Dtsch Der- matol Ges. 2024;22(7):922-934. DOI: 10.1111/ddg.15440. PMID: 38924688. 34. Madarasingha NP, Thabrew H, Uhrlass S, et al. Dermatophy- tosis caused by Trichophyton indotineae (Trichophyton men- tagrophytes ITS Genotype VIII) in Sri Lanka. Am J Trop Med Hyg. 2024;111(3):575-577. DOI: 10.4269/ajtmh.24-0027. PMID: 38981494. 35. Chua KY, Halliday CL, Chen SC, et al. Treatment-resistant tinea caused by Trichophyton indotineae in Australia. Med J Aust. 2024;221(4):192-194. DOI: 10.5694/mja2.52386. PMID: 39013435. 36. Smith A, Wong-O’Brien B, Lieberman JA, Cookson BT, Grinager E, Truong TT. The brief case: a case of tinea corporis caused by drug-resistant Trichophyton indotineae identified by broad-range fungal DNA sequencing. J Clin Microbiol. 2024;62(8):e0023424. DOI: 10.1128/jcm.00234-24. PMID: 39140757. 37. Mochizuki T, Anzawa K, Bernales-Mendoza AM, Shimizu A. Case of tinea corporis caused by a terbinafine-sensitive Tricho- phyton indotineae strain in a Vietnamese worker in Japan. J Der- matol. 2024. Published online. DOI: 10.1111/1346-8138.17463. PMID: 39269204. 38. Tan TY, Wang YS, Wong XYA, et al. First reported case of Tricho- phyton indotineae dermatophytosis in Singapore. Pathology. 12. Jia S, Long X, Hu W, et al. The epidemic of the multiresistant dermatophyte Trichophyton indotineae has reached China. Front Immunol. 2022;13:1113065.DOI: 10.3389 /fimmu.2022.1113065. PMID: 36874152. 13. Bortoluzzi P, Prigitano A, Sechi A, et al. Report of terbinafine re- sistant Trichophyton spp. in Italy: clinical presentations, molecu- lar identification, antifungal susceptibility testing and mutations in the squalene epoxidase gene. Mycoses. 2023;66(8):680-687. DOI: 10.1111/myc.13597. PMID: 37139949. 14. Kong X, Song G, Mei H, et al. The domestic isolation of terbinafine- and itraconazole-resistant Trichophyton indotineae in Chinese Mainland. Mycopathologia. 2023;188(4):383-393. DOI: 10.1007/s11046-023-00761-x. PMID: 37335400. 15. Tamimi P, Fattahi M, Firooz A, et al. Recalcitrant der- matophyte infections: identification and risk factors. Int J Dermatol. 2024;63(10):1398-1403. DOI: 10.1111/ijd.17145. PMID: 38712801. 16. Caplan AS, Todd GC, Zhu Y, et al. Clinical course, antifungal susceptibility, and genomic sequencing of Trichophyton indot- ineae. JAMA Dermatol. 2024;160(7):701-709. DOI: 10.1001 /jamadermatol.2024.1126. PMID: 38748419. 17. Ngo TMC, Santona A, Ton Nu PA, et al. Detection of terbinafine-resistant Trichophyton indotineae isolates within the Trichophyton mentagrophytes species complex isolated from patients in Hue City, Vietnam: a comprehensive analysis. Med Mycol. 2024;62(8):myae088. DOI: 10.1093/mmy/myae088. PMID: 39174488. 18. Hiruma J, Kimura U, Noguchi H, Hiruma M, Harada K, Kano R. In vitro azole susceptibility testing of Japanese isolates of terbinafine-resistant Trichophyton indotineae and Trichophyton rubrum. Med Mycol J. 2023;64(1):23-5. DOI: 10.3314/mmj.22 -00021. PMID: 36858630. 19. Dellière S, Joannard B, Benderdouche M, et al. Emergence of difficult-to-treat tinea corporis caused by Trichophyton men- tagrophytes complex isolates, Paris, France. Emerg Infect Dis. 2022;28(1):224-228. DOI: 10.3201/eid2801.210810. PMID: 34932462. 20. Jabet A, Brun S, Normand AC, et al. Extensive dermatophyto- sis caused by terbinafine-resistant Trichophyton indotineae, France. Emerg Infect Dis. 2022;28(1):229-233. DOI: 10.3201 /eid2801.210883. PMID: 34932456. 21. Ngo TMC, Ton Nu PA, Le CC, Ha TNT, Do TBT, Tran Thi G. First detection of Trichophyton indotineae causing tinea corpo- ris in Central Vietnam. Med Mycol Case Rep. 2022;36:37-41. DOI: 10.1016/j.mmcr.2022.05.004. PMID: 35620657. 22. Durdu M, Kandemir H, Karakoyun AS, Ilkit M, Tang C, de Hoog S. First terbinafine-resistant Trichophyton indotineae isolates with Phe(397)Leu and/or Thr(414)His mutations in Turkey. My- copathologia. 2023;188(1):2.DOI: 10.1007/s11046-023-00708 -2. PMID: 36656402. 23. Caplan AS, Chaturvedi S, Zhu Y, et al. Notes from the field: first reported U.S. cases of tinea caused by Trichophyton indotineae-New York City, December 2021-March 2023. MMWR Morb Mortal Wkly Rep. 2023;72(19):536-537. DOI: 10.15585/ mmwr.mm7219a4. PMID: 37167192. 24. Russo G, Toutous Trellu L, Fontao L, Ninet B. Towards an early clinical and biological resistance detection in dermatophyto- sis: about 2 cases of Trichophyton indotineae. J Fungi (Basel). 2023;9(7):733. DOI: 10.3390/jof9070733. PMID: 37504722. Review | Dermatol Pract Concept. 2025;15(4):5517 11 43. Abdolrasouli A, Borman AM, Johnson EM, Hay RJ, Arias M. Terbinafine-resistant Trichophyton indotineae causing exten- sive dermatophytosis in a returning traveller, London, UK. Clin Exp Dermatol. 2024;49(6):635-637. DOI: 10.1093/ced/llae042. PMID: 38320217. 44. Bui TS, Chan JB, Katz KA. Extensive multidrug-resistant derma- tophytosis from Trichophyton indotineae. Cutis. 2024;113(6): E20-23. DOI: 10.12788/cutis.1050. PMID: 39082990. 45. Sonego B, Corio A, Mazzoletti V, et al. Trichophyton indotin- eae, an emerging drug-resistant dermatophyte: a review of the treatment options. J Clin Med. 2024;13(12):3558. DOI: 10.3390 /jcm13123558. PMID: 38930086. 46. Jabet A, Normand AC, Brun S, et al. Trichophyton indotineae, from epidemiology to therapeutic. J Mycol Med. 2023;33(3):101383. DOI: 10.1016/j.mycmed.2023.101383. PMID: 37031652. 47. Hui ST, Gifford H, Rhodes J. Emerging antifungal resistance in fungal pathogens. Curr Clin Microbiol Rep. 2024;11(2):43-50. DOI: 10.1007/s40588-024-00219-8. PMID: 38725545. 2024;56(6):909-913. DOI: 10.1016/j.pathol.2024.04.003. PMID: 38937185. 39. Carroll E, Leahy M, Stanciu M, Laing M. Trichophyton indot- ineae: first case in Ireland and response to topical griseofulvin. Clin Exp Dermatol. 2024;49(12):1707-1708. DOI: 10.1093/ced /llae264. PMID: 39005069. 40. Gueneau R, Joannard B, Haddad N, et al. Extensive derma- tophytosis caused by terbinafine-resistant Trichophyton in- dotineae, successfully treated with topical voriconazole. Int J Antimicrob Agents. 2022;60(5-6):106677. DOI: 10.1016/j .ijantimicag.2022.106677. PMID: 36184016. 41. Villa-Gonzalez JM, Pascual Ares M, López-Soria LM, Gonzalez-Hermosa MR, Gardeazabal García J, Lasa Elgezua O. Extensive tinea corporis caused by Trichophyton indotineae: re- port of a case in Spain. J Eur Acad Dermatol Venereol. 2024;38(1): e22-23. DOI: 10.1111/jdv.19404. PMID: 37556851. 42. Xie W, Kong X, Zheng H, et al. Rapid emergence of recalci- trant dermatophytosis caused by a cluster of multidrug-resistant Trichophyton indotineae in China. Br J Dermatol. 2024;190(4): 585-587. DOI: 10.1093/bjd/ljae009. PMID: 38180270.