Terbinafine‐resistant T. indotineae due to F397L/L393S or F397L/L393F mutation among corticoid‐related tinea incognita patients

Summary Tinea incognita (TI) can mimic other dermatoses, presenting a diagnostic challenge for dermatologists. In some uncertain cases, it is crucial to accurately identify the causative agent using internal transcribed spacer (ITS) sequencing. The global issue of drug‐resistant dermatophytosis is i...

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Published in:Journal der Deutschen Dermatologischen Gesellschaft 2024-07, Vol.22 (7), p.922-934
Main Authors: Tamimi, Pegah, Fattahi, Mahsa, Ghaderi, Aliasghar, Firooz, Alireza, Shirvani, Fariba, Alkhen, Ahmed, Zamani, Shayan
Format: Article
Language:English
Subjects:
Amino acid substitution
Dermatomycosis
Eczema
Epidemiology
immunosuppressive medications
Mutation
Squalene
Squalene epoxidase
Terbinafine
terbinafine resistance
Tinea
tinea incognita
topical corticosteroids
Trichophyton indotineae
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container_title Journal der Deutschen Dermatologischen Gesellschaft
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Fattahi, Mahsa
Ghaderi, Aliasghar
Firooz, Alireza
Shirvani, Fariba
Alkhen, Ahmed
Zamani, Shayan
description Summary Tinea incognita (TI) can mimic other dermatoses, presenting a diagnostic challenge for dermatologists. In some uncertain cases, it is crucial to accurately identify the causative agent using internal transcribed spacer (ITS) sequencing. The global issue of drug‐resistant dermatophytosis is increasing, with Trichophyton (T.) indotineae being the main cause. This study presents four cases of TI (diagnosed as eczema) by terbinafine‐resistant T. indotineae strains and reviews the current global TI epidemiology based on geographical continent and related conditions. Furthermore, squalene epoxidase (SQLE)‐associated resistance mechanisms are evaluated. Lesions caused by terbinafine‐resistant T. indotineae strains do not respond to allylamine antifungals, thus allowing the infection to spread. Among T. indotineae isolates, the SQLE F397L substitution is the most prevalent mutation contributing to azole resistance. F397L and L393F replacements in SQLE were detected in all isolates that exhibited high‐level resistance. L393S was seen in isolates with low‐resistant strains. Interestingly, and for the first time, an L393F amino acid substitution in the SQLE gene product was detected in the Iranian clinical T. indotineae strain. Also, a genomics‐based update on terbinafine resistance that focuses on T. indotineae is discussed in this study.
doi_str_mv 10.1111/ddg.15440
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In some uncertain cases, it is crucial to accurately identify the causative agent using internal transcribed spacer (ITS) sequencing. The global issue of drug‐resistant dermatophytosis is increasing, with Trichophyton (T.) indotineae being the main cause. This study presents four cases of TI (diagnosed as eczema) by terbinafine‐resistant T. indotineae strains and reviews the current global TI epidemiology based on geographical continent and related conditions. Furthermore, squalene epoxidase (SQLE)‐associated resistance mechanisms are evaluated. Lesions caused by terbinafine‐resistant T. indotineae strains do not respond to allylamine antifungals, thus allowing the infection to spread. Among T. indotineae isolates, the SQLE F397L substitution is the most prevalent mutation contributing to azole resistance. F397L and L393F replacements in SQLE were detected in all isolates that exhibited high‐level resistance. L393S was seen in isolates with low‐resistant strains. Interestingly, and for the first time, an L393F amino acid substitution in the SQLE gene product was detected in the Iranian clinical T. indotineae strain. 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Interestingly, and for the first time, an L393F amino acid substitution in the SQLE gene product was detected in the Iranian clinical T. indotineae strain. 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Interestingly, and for the first time, an L393F amino acid substitution in the SQLE gene product was detected in the Iranian clinical T. indotineae strain. Also, a genomics‐based update on terbinafine resistance that focuses on T. indotineae is discussed in this study.</abstract><cop>Germany</cop><pub>Wiley Subscription Services, Inc</pub><pmid>38924688</pmid><doi>10.1111/ddg.15440</doi><tpages>13</tpages></addata></record>
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subjects Amino acid substitution
Dermatomycosis
Eczema
Epidemiology
immunosuppressive medications
Mutation
Squalene
Squalene epoxidase
Terbinafine
terbinafine resistance
Tinea
tinea incognita
topical corticosteroids
Trichophyton indotineae
title Terbinafine‐resistant T. indotineae due to F397L/L393S or F397L/L393F mutation among corticoid‐related tinea incognita patients
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