CURRENT STATE OF DERMATOPHYTE RESISTANCE TO ANTIMYCOTIC AGENTS

Abstract

Background: As the use of antifungals to control mycoses caused by dermatophytes becomes more common, there is 
growing concern about increasing cases of antifungal resistance. Currently, this problem is similar to the problems of resistance to antibacterial and antiviral drugs. 
Aim: Analysis of scientific information on the current state of resistance of pathogens of dermatophytic skin infections to 
antifungal drugs. 
Search strategy: The search for scientific publications was conducted in databases PubMed, Elsiever, Medline, 
GoogleScholar. A total of 71 sources published within the past 10 years were selected for analysis. The inclusion criteria 
were full-text publications in English and Russian published within the past 10 years. Exclusion criteria included abstracts, 
duplicate articles, publications prior to 2013, and irrelevant studies. 
Results: Antifungal resistance can occur naturally or develop over time when fungi are exposed to antifungal drugs. Several 
mechanisms have been proposed to explain the phenomenon of antifungal drug resistance, such as drug efflux by fungal cells, drug 
detoxification by fungal cells, mutations in target genes, and resistance due to fungal cell structural elements, etc. Frequency of 
terbinafine-resistant isolates Trichophyton increases. Opportunistic pathogens such as Aspergillus and Candida species have 
developed resistance to classic azoles such as itraconazole and fluconazole, as well as to new azoles such as posaconazole and 
voriconazole. Topical antimycotics such as efinaconazole and tavaborole are rarely used but have been associated with resistance 
in Trichophyton rubrum. The emergence of multidrug-resistant Trichophyton mentagrophytes/interdigitale, Candida auris and 
Aspergillus species causing severe infections is of grave concern. 
Conclusion: Routine AFST should be considered to determine the most effective treatment, especially in cases of 
treatment failure. Combination treatment with oral and topical antifungals may be considered for the treatment of resistant 
infections.