Antifungal resistance in dermatophytosis: A global health concern

Abstract

Dermatophytosis is a common dermatological problem in animals as well as humans which is associated with interference in immune function. Unlike the antibacterial resistance which is frequently reported, antifungal resistance is less commonly reported, but there are reports of emerging antifungal resistance in humans and animals. The problem of antifungal resistance can be more severe in comparison to any other drug resistance due to the limited number of antifungals available for therapeutic purpose. A number of mechanisms have been put forward to explain the phenomenon of antifungal drug resistance, such as, drug efflux by fungal cells, drug detoxification by fungal cells, resistance imposed by structural elements of the fungal cell, target gene mutations, etc. Currently, only three types of antifungal drugs are available – Azoles, Polyenes, and allylamines; therefore it is mandatory to use the antifungals rationally to contain the problem of rising antifungal resistance. To counter the problem of antifungal resistance indiscriminate over the counter use of antifungal drugs in the treatment of dermatophytosis need to be strongly discouraged. Furthermore, at the research level, whole genome sequencing of dermatophytes from around the world will aid in a better understanding of fungal pathophysiology and associated drug resistance, potentially leading to new approaches to overcome antifungal resistance. And, lastly the use of combination therapy offers an advantage of synergistic action of different antifungals with enhanced spectrum activity which could play instrumental role in reducing the antifungal resistance.