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Azole Resistance in Dermatophytes: Prevalence and Mechanism of Action

Mahmoud Ghannoum

    Journal of the American Podiatric Medical Association
    |February 20, 2016
    PubMed

    Insights

    Azole antifungals, unlike allylamines, promote resistance in dermatophytes. This review explores azole mechanisms of action and resistance, contrasting them with allylamines for better treatment strategies.

    Area of Science:

    • Mycology
    • Dermatology
    • Pharmacology

    Background:

    • Azole antifungal agents (e.g., fluconazole, itraconazole) are common treatments for superficial fungal infections.
    • Resistance to azoles is documented in yeasts and molds, with emerging reports in dermatophytes.
    • Allylamines (e.g., terbinafine, naftifine) are another class of antifungal agents.

    Purpose of the Study:

    • To review the mode of action of azole antifungals.
    • To elucidate mechanisms of azole resistance in dermatophytes.
    • To compare azole resistance with that of allylamine antifungals.

    Main Methods:

    • Comparative analysis of published and original study data.
    • Review of azole antifungal mechanisms of action.
    • Examination of ergosterol biosynthesis pathways and resistance mechanisms.

    Main Results:

    • Azoles are static antifungals, allowing mutations in ergosterol biosynthesis enzymes.
    • Accumulating ergosterol precursors from azole action are non-toxic.
    • Azoles, unlike cidal allylamines, potentiate resistance development in dermatophytes.

    Conclusions:

    • Azole antifungals contribute to resistance development in dermatophytes.
    • Understanding these mechanisms is crucial for managing superficial fungal infections.
    • Further research is needed to optimize antifungal therapies and combat resistance.

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