has emerged as a novel dermatophyte species resulting in treatment recalcitrant skin infections. While the earliest reports came from India, has now spread to many parts of the world and is rapidly becoming a global health concern. Accurate identification of requires elaborate mycological investigations which is beyond the domain of routine microbiology testing. Extensive, non-inflammatory and atypical presentations are commonly seen with this novel species. shows an alarmingly high rate of mutations in the squalene epoxidase gene leading to lowered in vitro susceptibility to terbinafine. This has also translated into a lowered clinical response and requirement of a higher dose and much longer durations of treatment with the drug. Although the species remains largely susceptible to itraconazole, prolonged treatment durations are required to achieve cure with itraconazole. Fluconazole and griseofulvin do not have satisfactory in vitro or clinical activity. Apart from requirement of prolonged treatment durations, relapse postsuccessful treatment is a distressing and yet unexplained consequence of this “species-shift.” Use of third generation azoles and combinations of systemic antifungals is unwarranted as both have not demonstrated clear superiority over itraconazole given alone, and the former is an important class of drugs for invasive mycoses.

中文翻译：

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印地毛癣菌时代皮肤癣菌感染的临床真菌学和治疗更新

已成为一种新型皮肤癣菌物种，可治疗顽固性皮肤感染。虽然最早的报告来自印度，但现已传播到世界许多地区，并迅速成为全球健康问题。准确鉴定需要进行详细的真菌学研究，这超出了常规微生物学测试的范围。这种新物种常见广泛的、非炎症性和非典型的表现。显示角鲨烯环氧酶基因的突变率惊人地高，导致体外对特比萘芬的敏感性降低。这也导致临床反应降低，需要更高剂量和更长的药物治疗持续时间。尽管该物种仍然对伊曲康唑很敏感，但需要延长治疗时间才能实现伊曲康唑治愈。氟康唑和灰黄霉素没有令人满意的体外或临床活性。除了需要延长治疗时间之外，治疗成功后的复发也是这种“物种转变”的令人痛苦且无法解释的后果。使用第三代唑类药物和全身抗真菌药物的组合是没有根据的，因为两者都没有表现出比单独使用伊曲康唑明显的优越性，而前者是治疗侵袭性真菌病的一类重要药物。