Ring of Fire: The Global Rise of Drug Resistant Ringworm and the Race to Outpace It: A Narrative Review of Dermatophytosis and Emerging Antifungal Resistance

Background: Dermatophytosis is one of the most common superficial fungal infections worldwide, but increasing antifungal resistance has transformed recurrent and treatmentresistant tinea into an emerging publichealth concern. Trichophyton indotineae has gained particular attention because of frequent terbinafine resistance.

Objective: This narrative review examines the epidemiology, clinical manifestations, diagnostic challenges, molecular mechanisms of antifungal resistance, and evolving therapeutic approaches in dermatophytosis.  

Discussion: Terbinafine resistance is strongly associated with mutations in the squalene epoxidase (SQLE) gene, while additional mechanisms may contribute to reduced antifungal susceptibility. Accurate species identification and antifungal susceptibility testing are increasingly important in refractory infections. Itraconazole remains an important therapeutic option, while newer antifungal agents are being investigated.  

Conclusion: Drugresistant dermatophytosis highlights the need for improved surveillance, diagnostic capacity, rational antifungal use, and continued development of effective treatment strategies.