Trichophyton indotineae in New York: A Case Series Highlighting Diagnostic Pitfalls and Therapeutic Considerations

To describe the clinical characteristics, treatment responses, and outcomes of patients with Trichophyton indotineae infection in New York state and to contribute to the collective knowledge necessary for appropriate antifungal stewardship and management strategies.

We conducted a retrospective cohort study of 20 patients with culture-confirmed T. indotineae infection seen across New York City between June 2023 and April 2025. Demographic data, clinical features, medical history, and treatment outcomes were collected. All patient data were deidentified, and informed consent was waived.

Patients were evenly distributed by gender, with a mean age of 43.8 years for men and 33.4 years for women. All patients reported pruritus and, notably, 90% had intact immune function. Common presentations included tinea corporis and tinea cruris. Itraconazole was the most effective first-line therapy; however, there was a high rate of recurrence after stopping the treatment. Griseofulvin, voriconazole, and fluconazole showed some success.

This study is limited by a small sample size and reliance on self-reported medical histories. Additionally, the study did not assess the impact of topical antifungal use or combination oral antifungal therapy on treatment efficacy.

T. indotineae presents diagnostic and therapeutic challenges due to its atypical clinical features and antifungal resistance. Early recognition and appropriate systemic antifungal therapy are critical. Itraconazole remains the preferred first-line agent based on current clinical experience. Greater clinician awareness and further research are urgently needed to address the rising burden of this infection.