Survey on Difficult-to-Treat Tinea: A Sub-Saharan African Snapshot

Tinea or dermatophyte infections pose a significant therapeutic challenge in many African countries, exacerbated by limited diagnostic resources and treatment failure. This survey aimed to evaluate treatment difficulties, laboratory access, and antifungal use patterns among healthcare providers across ten African countries.

An exploratory survey was performed during the Continuing Medical Education meeting at the Regional Dermatology Training Centre, Moshi, on January 8, 2025. The collected data included information on clinical response to antifungal treatment, access to laboratory diagnostics, antifungal agents used, and affected body sites. The term "difficult-to-treat tinea" in this survey implied a dermatophyte infection that has either failed to respond to oral or topical antifungal therapies that, in experience, would normally clear the infection or which has relapsed within 4 weeks of completing such treatment. Descriptive analysis and cross-tabulations were performed to identify key trends.

The response rate was 92.6%. Treatment difficulties were reported by 95.1% of respondents, and more than half of those surveyed (54.3%) lacked access to laboratory services necessary for accurate diagnosis. Empirical use of multiple antifungal medications was common (77.2%), particularly in cases involving more than one body site (62%). Although in this survey, the participants were asked about antifungal usage, no information was gathered on topical corticosteroids or topical steroid combinations.

This survey highlights the widespread occurrence of treatment failure in tinea or dermatophyte infections as well as critical gaps in the facilities for diagnosis and management of these infections across African countries.