Dermatophytosis: An Update on Global Epidemiology

Dermatophytosis is a cutaneous mycosis caused by keratinolytic fungi, classified as dermatophytes, affecting 20-25% of the global population and representing a significant public health concern. The disease manifests as circular, erythematous, pruritic, and desquamative skin lesions, hair breakage and loss, and nail degradation, leading to considerable morbidity. In addition, dermatophytosis can markedly impair patients' quality of life. Despite the high global prevalence of dermatophytosis, the causative agents are often misdiagnosed, and there is limited data on the epidemiology and genomic surveillance of dermatophytosis worldwide. This review aims to update the global epidemiology of dermatophytosis and dermatophytes while addressing their taxonomy, pathogenesis, virulence factors, clinical manifestations, and antifungal therapy. Consistently, Trichophyton spp., particularly T. rubrum, T. mentagrophytes, and T. interdigitale, remain the predominant pathogens worldwide. Recently, T. indotineae has gained prominence due to its global dissemination, significant terbinafine resistance, extensive lesions, therapeutic failure, and recurrence. Furthermore, studies have reported endogenous cases of T. indotineae infections in Asia and Europe, and exogenous reports in the Americas and Oceania. Among non-Trichophyton dermatophytes, Microsporum canis and M. audouinii stand out as relevant pathogens, particularly in endemic regions and specific clinical settings, such as scalp infections. Overall, these factors emphasize the importance of global vigilance regarding dermatophyte dissemination. This review also highlights a discrepancy between accurate fungal identification and global reporting, raising concerns regarding epidemiological surveillance and underscoring the need for improved strategies to manage dermatophytosis worldwide.