UKHSA Issues Alert: Surge in Antifungal-Resistant Trichophyton indotineae Cases
- Mohammed A Rashad
- 7 days ago
- 5 min read
Forty per cent of dermatophyte samples tested by the UK Health Security Agency in 2024 have shown resistance to terbinafine, the frontline antifungal treatment. This dramatic surge in antifungal-resistant Trichophyton indotineae is not just a laboratory statistic—it is a growing clinical challenge now affecting patients across the UK, often presenting as stubborn, persistent skin infections that defy standard therapies.
The implications are significant for clinicians and patients alike. With cases linked to travel and treatment failures and the potential for rapid community spread, understanding the signs, risks, and best practices for prevention has never been more urgent. The Medicines Management Team is here to guide you through the latest UKHSA alert, offering practical advice and expert insight to help you stay ahead of this
evolving threat.
Key Takeaways
What is Trichophyton indotineae?
Trichophyton indotineae is an emerging fungal pathogen responsible for a growing number of skin infections, particularly tinea corporis, commonly known as ringworm. Unlike more familiar dermatophytes, T. indotineae is notable for its aggressive spread and its ability to cause persistent, inflamed lesions, especially in the groin, buttocks, and thighs.
These infections can be uncomfortable, unsightly, and, as recent data shows, increasingly difficult to treat.
Trichophyton indotineae Causes
The primary cause of Trichophyton indotineae infection is direct skin-to-skin contact with an infected person or indirect contact through contaminated items such as towels, clothing, or bedding. The risk is higher in warm, humid environments and among individuals who share personal items or live in close quarters.
Travel to regions where T. indotineae is prevalent, particularly South Asia, is a significant risk factor, as is exposure to individuals who have recently travelled to these areas.
The Rise of Antifungal Resistance
Alarming Statistics from UKHSA
The UK Health Security Agency (UKHSA) has reported that 40% of dermatophyte isolates tested in 2024 are now resistant to terbinafine, the most commonly prescribed antifungal for tinea infections. This marks a significant shift in the landscape of fungal infections, as terbinafine resistance was previously rare in the UK.
Why is Resistance Increasing?
Several factors are driving this surge in resistance:
Overuse and Misuse of Antifungals Inappropriate or incomplete use of antifungal medications can allow resistant strains to survive and multiply.
Global Travel Increased travel to and from regions where T. indotineae is prevalent, particularly South Asia, has facilitated the spread of resistant strains.
Delayed or Incorrect Diagnosis Misdiagnosis or delayed diagnosis can lead to prolonged infection and increased risk of resistance developing.
Impact on Treatment and Public Health
Antifungal resistance means that standard treatments may fail, leading to prolonged infections, increased discomfort, and a higher risk of transmission. This creates a need for alternative therapies and more robust infection control measures for healthcare providers. For patients, it can mean longer recovery times and more complex treatment regimens.
Trichophyton indotineae Symptoms and Who is at Risk?
Recognising Trichophyton indotineae Symptoms
Trichophyton indotineae symptoms can vary, but commonly include:
Red, scaly, and inflamed patches on the skin, often with a raised border
Persistent itching and discomfort
Lesions that do not respond to standard antifungal treatments
Spread of infection to multiple body sites, especially the groin, buttocks, and thighs
Key Risk Groups
Certain groups are more likely to be affected by antifungal-resistant T. indotineae:
Individuals with persistent or recurrent tinea infections Especially those affecting the groin, buttocks, or thighs.
People with a recent history of travel to South Asia Many cases in the UK have been linked to travel or contact with travellers from high-prevalence regions.
Patients who have failed standard terbinafine treatment Treatment failure should raise suspicion for resistance.
Recognising the Signs
Healthcare professionals should be alert to the following:
Lesions that do not improve after a full course of terbinafine.
Worsening or spreading of infection despite treatment.
Family or close contacts with similar symptoms, suggesting possible transmission.
Trichophyton indotineae Identification and Diagnosis
When to Suspect Resistant T. indotineae
If a patient presents with persistent tinea corporis, particularly in the groin, buttocks, or thighs, and has a history of travel to South Asia or has not responded to standard treatment, resistant T. indotineae should be considered.
Steps for Accurate Diagnosis
Clinical Assessment Evaluate the appearance, location, and duration of lesions. Take a detailed travel and treatment history.
Laboratory Testing If resistance is suspected, collect skin scrapings for fungal culture and sensitivity testing.
Referral to UKHSA Mycology Reference Laboratory If the diagnosis is uncertain or resistance is suspected, refer samples to the UKHSA Mycology Reference Lab for confirmation and further analysis.
Management and Treatment Strategies
Challenges in Treating Resistant Infections
Terbinafine-resistant T. indotineae infections require alternative approaches, as standard therapies may be ineffective. This can complicate management and increase the risk of ongoing transmission.
Alternative Treatment Options
Itraconazole Oral itraconazole is often effective against resistant strains, but should be prescribed with caution and under specialist guidance due to potential drug interactions and side effects.
Other Systemic Antifungals In some cases, other systemic antifungals may be considered, based on susceptibility testing.
Topical Treatments While topical antifungals may provide some benefit, they are generally less effective for extensive or resistant infections.
The Role of The Medicines Management Team (TMMT)
The Medicines Management Team supports healthcare professionals by:
Providing up-to-date guidance on antifungal prescribing.
Advising on referral pathways and laboratory testing.
Offering patient education materials to support adherence and prevention.
Hygiene and Prevention Advice
Essential Hygiene Measures
Preventing the spread of antifungal-resistant T. indotineae requires strict attention to hygiene. Patients and their families should be advised to:
Wash clothes, towels, and bedding at high temperatures (60°C or above) to kill fungal spores.
Avoid sharing personal items such as towels, clothing, and bedding.
Keep lesions covered to reduce the risk of transmission to others.
Maintain good personal hygiene, including regular handwashing.
Community and Household Prevention
Educate all household members about the importance of not sharing personal items.
Encourage prompt treatment of any new or persistent skin lesions in close contacts.
Inform schools, gyms, and other community settings if there is a risk of wider transmission.
Patient Education Tips
Explain the importance of completing the full course of prescribed antifungal treatment, even if symptoms improve.
Advise patients to return for follow-up if lesions do not resolve or if new symptoms develop.
Provide clear written instructions on hygiene and prevention to reinforce verbal advice.
Conclusion
The rise in antifungal-resistant Trichophyton indotineae is a pressing concern for both healthcare professionals and the public. With 40% of dermatophyte isolates now showing resistance to terbinafine, vigilance, accurate diagnosis, and robust hygiene practices are more important than ever. The Medicines Management Team is committed to supporting clinicians and patients with the latest guidance, practical advice, and resources to help manage and prevent the spread of this challenging infection.
Stay informed, follow UKHSA recommendations, and do not hesitate to contact TMMT for expert support in managing antifungal-resistant fungal infections. Together, we can help protect our communities and ensure the best outcomes for all.
Contact us to learn how we can help.
FAQs
How do you treat Trichophyton indotineae?
Treatment of Trichophyton indotineae often requires oral antifungal medications, such as itraconazole, especially if the infection is resistant to terbinafine. It is important to follow specialist advice and complete the full course of treatment to ensure the infection is fully cleared.
What disease does Trichophyton cause?
What is the best treatment for Trichophyton?
What is Trichophyton indotineae an emerging pathogen causing?
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