Dermatophytosis, caused by dermatophytes is becoming difficult to treat due to various reasons. Accurate diagnosis is essential for the accurate management of this infection and prevention of relapse or recurrence. Although this condition is easy to diagnose clinically, due to overlapping signs and symptoms of few dermatological conditions it may be misdiagnosed necessitating laboratory confirmation. Isolation, identification of the dermatophytes and the antifungal susceptible profile may further help to initiate appropriate antifungal agent. The classical conventional techniques such as direct microscopic examination and isolation of fungi from the clinical specimens are still considered as an important modality of diagnosis. With the rise of the molecular era, molecular techniques are increasingly being applied to diagnose dermatophytosis and identify the dermatophytes. The present review provides an overview and update on the laboratory diagnosis of dermatophytosis.

In the recent past, there has been an alarming rise in patients presenting with atypical clinical types of dermatophytosis. These patients require prolonged treatment with systemic and topical antifungal agents. In majority of patients, close household contacts are affected. Frequent relapses and extensive disease affect the quality of life of the patient significantly. The emergence of such a challenging scenario is attributed to complex interplay of host, environment, and agent factors. The change in prevalence of dermatophytes causing the disease; host factors such as comorbidity and immunosuppression; and hot and humid climate, lifestyle changes, and poor hygiene are responsible for atypical dermatophytosis. Several atypical clinical types such as psoriasis-like, eczematous dermatitis-like, seborrheic dermatitis-like, and rosacea-like have been reported. Hence, dermatophytosis has been suggested to be included in the list of great imitators. The collaborative effort involving dermatologists, microbiologists, and public health professionals is required to address this emerging public health problem.

Superficial dermatophytosis caused by dermatophytes belonging to the three genera, “Trichophyton, Microsporum and Epidermophyton” is the most common fungal infection seen in human beings, worldwide. Medical fraternity in India has been observing an increase in the prevalence of dermatophytosis and that too of the difficult to treat recalcitrant, recurrent and chronic dermatophytosis, over the last 3-4 years. This change in the clinical scenario with increasing frequency of treatment failures has given rise to innumerable treatment options mainly based on individual's experience, as the therapeutic regimens given in the standard textbooks, both Western and Indian, have ceased to result in a good clinical response. With this background, this article will focus on the treatment schedule given in standard textbooks and the current modifications that have evolved to treat dermatophytosis of the glabrous skin.

Topical antifungals are an important adjuvant in treatment of dermatophytosis. Also specific situations such as dermatophytoses in pregnancy and infants often warrant topical therapy. Several new topical antifungals and newer formulations hold out the promise of enhanced effectiveness of topical therapy in dermatophytosis. This article reviews the entire spectrum of topical antifungals and formulations and their role in management of dermatophytosis.

Dermatophyte infections are common worldwide, and dermatophytes are the prevailing causes of fungal infection of the skin, hair, and nails. These infections lead to a variety of clinical manifestations; nail infection known as onychomycosis (OM) and hair infection as Tinea capitis. The diagnosis and treatment of dermatophyte infections of the Nail and hair will be reviewed here.

Chronic and recurrent dermatophytosis is on the rise. Managing dermatophytosis in special circumstances such as pregnancy and lactation and in children is a challenge. Topicals are safe in most cases, whereas oral antifungals are better avoided in pregnancy and lactation. In children, systemic antifungals are to be dose modified according to body weight.

Various factors unique to elderly patients such as physical, physiological, psychological, and socioeconomic factors affect the outcome of dermatophytic infection and its management. The associated comorbidities such as renal and hepatic failure and polypharmacy influence the pharmacological properties of antifungal agents. These drugs are potent inhibitors of hepatic enzymes involved in drug metabolism leading to accumulation and subsequent toxicity of various classes of drugs. All these factors are considered in the management of dermatophytosis in elderly especially with comorbidities.