REVIEW article
Front. Microbiol.
Sec. Infectious Agents and Disease
Rising antifungal resistance in Trichophyton species - the bleak future for treatment of dermatomycoses?
Provisionally accepted
- 1Klinik für Hautkrankheiten, Universitätsklinikum Jena, Jena, Germany
- 2Labopart-Medizinische Laboratorien, Rötha OT Mölbis, Germany
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Dermatophyte infections, particularly those caused by Trichophyton species, represent a significant global health concern due to their high prevalence and increasing resistance to commonly used antifungal agents. While traditionally regarded as treatable with topical or systemic antifungals such as terbinafine and azoles, recent epidemiological shifts and misuse of antifungal medications have led to the emergence of multidrug-resistant strains, most notably Trichophyton indotineae (T. mentagrophytes subtype VIII). Resistance is often associated with genetic mutations in target enzymes and overexpression of efflux pumps. Inadequate treatment regimens, prolonged monotherapies, and combination with corticosteroids further exacerbate the selection of resistant isolates. Antifungal stewardship (AFS) is essential to combat resistance development. This includes targeted therapy based on mycological diagnostics, identification of the causative species, and appropriate patient education. Current antifungal therapies are limited to a few drug classes, and their efficacy is challenged by poor tissue penetration and subtherapeutic drug levels at infection sites. Innovative formulations and delivery systems may improve bioavailability and therapeutic outcomes. Combination therapies and the use of efflux pump inhibitors may offer additional options for recalcitrant infections. Ultimately, the growing resistance among Trichophyton species highlights an urgent need for novel antifungal agents, advanced diagnostics, and globally coordinated stewardship programs to safeguard the future of dermatomycosis treatment.
Keywords: antifungal resistance, Antimycotic therapy, Dermatomycoses, Multidrug-resistant fungi, Trichophyton
Received: 14 Oct 2025; Accepted: 26 Jan 2026.
Copyright: © 2026 Burmester, Tittelbach, Uhrlass, Nenoff, Fabri and Wiegand. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Cornelia Wiegand
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