Recalcitrant dermatophytosis due to Trichophyton indotineae: A case series from Sarawak, Malaysia

Abstract

The development of terbinafine-resistant Trichophyton indotineae has made the treatment of dermatophytosis a challenging task globally. We herein report three recalcitrant tinea infections in Sarawak, Malaysia. The ITS sequencing and phylogenetic analysis have confirmed T. indotineae. Furthermore, all isolates carried the Leu393Ser mutation in the SQLE gene, and associated with high terbinafine MICs. However, the voriconazole and itraconazole susceptibilities were variable. The successful azole therapy guided by susceptibility testing (voriconazole/itraconazole) had achieved clinical resolution in one case.