DermWorld Academy Insider: New drug-resistant dermatophytes: What to know
Aug. 6, 2024
The Academy’s Emerging Diseases Task Force recently released new resources about drug-resistant dermatophytes. Over the past decade, antifungal-resistant dermatophytes have become a global public health issue, including in the United States.
The new resources include information sheets on disease recognition, diagnosis, and other treatment options, as well as a registry to report cases. In this exclusive DermWorld Academy Insider interview, Esther Freeman, MD, PhD, FAAD, and Misha Rosenbach, MD, FAAD, chair and deputy chair of the task force, discuss drug-resistant dermatophytes, the new resources, and why members should make use of them.
DermWorld: What are drug-resistant dermatophytes?
Dr. Rosenbach: Dermatophytes are a very common cause of routine skin fungal infections, often referred to colloquially as “ringworm,” though there are a few forms. Normally, these are fairly easy to treat with antifungal medications. Recently, some of these infections have been found that are harder to treat, as the causative organism — the dermatophyte — has acquired resistance to standard treatment. Many people are familiar with the concept of “antibiotic-resistant bacteria,” including things like MRSA, which stands for methicillin-resistant-staph-aureus (a form of staph aureus which is resistant to previously commonly used antibiotics — methicillin and that family). This is that same concept, but with dermatophyte skin infections.
DermWorld: Why should members be concerned?
Dr. Freeman: Drug resistance is a growing problem for many different types of infectious disease. Because superficial fungal infections are so common, antifungal-resistant dermatophytes are an issue that can potentially affect many people. On the individual level, this can mean it will be harder to treat our patients with existing medications. On a population level, this could mean outbreaks and increasing numbers of hard-to-treat infections. At present, infections with antifungal-resistant dermatophytes are hard to diagnose with tests available in the community, which means this is likely a very underestimated, and global, problem.
Dr. Rosenbach: Drug resistance generally means infections are harder to treat. If physicians are not aware of the potential for drug-resistant infections, it may mean that patients will undergo repeated rounds of ineffective treatment, and that may allow the infection to persist and/or spread, either on the patient or to others, more readily. Resistant infections require different treatments, and dermatologists need to know that this can happen, when to think about whether this could be happening, how to confirm if it is happening, and how to treat patients once they suspect drug-resistant dermatophyte infections.
DermWorld: What can members expect to learn from the new resources?
Dr. Freeman: The resources present a practical source of information for practicing dermatologists and other front line health care workers that may encounter drug-resistant dermatophyte infections. We focus on ways to approach diagnosis, where to find additional resources, approaches to treatment (currently there are no national or international guidelines on how to treat), and also how to register cases through the Emerging Diseases Registry, which now has a drug-resistant dermatophyte module. We deeply appreciate the input from colleagues at the CDC, including Jeremy Gold and Dallas Smith, as well as expert dermatologists like Avrom Caplan, the AAD Emerging Diseases Task Force, and UK and European colleagues including Rod Hay, Ditte Saunte, and Sidra Khan, in developing these resources, and we hope you find them useful.
Dr. Rosenbach: Mostly it’s an awareness issue — this is, for many dermatologists/readers, likely a new concept. It’s critically important that dermatologists are aware of the spread of drug-resistant dermatophyte infections — not just internationally or in travelers, but in patients here in the U.S. They will learn: how and when to consider this in the differential; clues in terms of distribution, history, and response (or non-response!) to treatment; resources to use for guidance in confirmatory testing and empiric or directed treatments; and ways to report these illnesses. Importantly, too, dermatologists will learn that our field has been, and is, playing a critical role in identifying and managing emerging diseases. Dermatologists should be aware that the AAD has supported efforts enabling dermatologists and CDC experts to work together to identify, track, and treat emerging diseases in general and these drug-resistant dermatophyte infections in particular.
DermWorld: How should members make use of the new resources?
Dr. Freeman: Take a look at the new Emerging Diseases Resource Center. We have a new area on drug-resistant dermatophytes, which includes information on recognition and diagnosis, treatment, and also a link to the registry. You’ll also find links to our prior work on other outbreaks, including Mpox and COVID-19.
Dr. Rosenbach: I would encourage everyone to go to the website and click around. It will take most folks just a few minutes. There’s a lot of information available, but it’s very well curated and easily navigated, so even in a very busy practice, it’s quick and easy to go to the site and find information about testing, treatment, or links to things like the registry to collect some information on these cases and get a better handle on the extent of this issue. I would encourage all dermatologists to be aware of this issue and stay up to date in general, and the website I think helps put key information at everyone’s fingertips, to enable better care of the individual patient and a better field-wide approach to understanding this emerging disease.
