Entangled: The New Era of Aggressive Dermatomycosis

The word “dermatomycosis” is derived from the Greek word “derma,” meaning skin, and “mykes,” meaning “mushroom.” It is an all-encompassing term that denotes fungal infection of the skin and its appendages. However, it has also been used in literature to denote cutaneous infection caused by non-dermatophytic molds (NDMs). The term “dermatophytosis” is only used when the infection is caused by a dermatophyte. However, these terms are often used interchangeably. Irrespective of the term used, there is no doubt that dermatophytosis has acquired an epidemic-like proportion in the Indian subcontinent [1–3]. The ever-increasing cases of recalcitrant (recurrent and chronic) dermatophytosis and therapeutic failure after first contact with general practitioners, needing a specialist’s opinion, are alarming. Despite being such a prevalent dermatological disease, and causing so much morbidity, the quality and quantity of research in this field are inadequate because of the lack of support and funding for research into this perceived “harmless” disease. There is an urgent need to study the immunopathogenesis of dermatophytosis to understand and develop new drug targets. With a limited armamentarium of antifungals effective against dermatophytes, and recent studies showing resistance, antifungal susceptibility patterns of clinically isolated dermatophytes need to be continually measured and monitored to determine the level of resistance prevalent in the community and form the basis for good drug selection for a cure. The drug resistance mechanisms and their prevalence also need to be thoroughly documented to enable the development of mechanisms to circumvent drug resistance, as well as to develop modalities that can enhance the effectiveness and longevity of the currently available antifungals.