Summary The disease burden of chronic‐relapsing and therapy‐refractory superficial dermatophytosis dramatically increased in India within the past 5‐6 years. In order to evaluate the prevalence of this trend, 201 skin scrapings were collected from patients from all parts of India and were tested for dermatophytes using both fungal culture and a PCR‐ELISA directly performed with native skin scrapings. Fungal culture material was identified by genomic Sanger sequencing of the internal transcribed spacer (ITS) region and the translation elongation factor (TEF)‐1α gene. In total, 149 (74.13%) out of the 201 samples showed a dermatophyte‐positive culture result. Out of this, 138 (92.62%) samples were identified as Trichophyton (T.) mentagrophytes and 11 (7.38%) as Trichophyton rubrum. The PCR‐ELISA revealed similar results: 162 out of 201 (80.56%) samples were dermatophyte‐positive showing 151 (93.21%) T mentagrophytes‐ and 11 (6.79%) T rubrum‐positive samples. In this study, we show for the first time a dramatic Indian‐wide switch from T rubrum to T mentagrophytes. Additionally, sequencing revealed a solely occurring T mentagrophytes “Indian ITS genotype” that might be disseminated Indian‐wide due to the widespread abuse of topical clobetasol and other steroid molecules mixed with antifungal and antibacterial agents.

Background An alarming increase in recalcitrant dermatophytosis has been witnessed in India over the past decade. Drug resistance may play a major role in this scenario. Objectives The aim of the present study was to determine the prevalence of in vitro resistance to terbinafine, itraconazole and voriconazole in dermatophytes, and to identify underlying mutations in the fungal squalene epoxidase (SQLE) gene. Patients/Methods We analysed skin samples from 402 patients originating from eight locations in India. Fungi were identified by microbiological and molecular methods, tested for antifungal susceptibility (terbinafine, itraconazole, voriconazole), and investigated for missense mutations in SQLE. Results Trichophyton (T.) mentagrophytes internal transcribed spacer (ITS) Type VIII was found in 314 (78%) samples. Eighteen (5%) samples harboured species identified up to the T interdigitale/mentagrophytes complex, and T rubrum was detected in 19 (5%) samples. 71% of isolates were resistant to terbinafine. The amino acid substitution Phe397Leu in the squalene epoxidase of resistant T mentagrophytes was highly prevalent (91%). Two novel substitutions in resistant Trichophyton strains, Ser395Pro and Ser443Pro, were discovered. The substitution Ala448Thr was found in terbinafine‐sensitive and terbinafine‐resistant isolates but was associated with increased MICs of itraconazole and voriconazole. Conclusions The high frequencies of terbinafine resistance in dermatophytes are worrisome and demand monitoring and further research. Squalene epoxidase substitutions between Leu393 and Ser443 could serve as markers of resistance in the future.

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<p class="abstract"><strong>Background:</strong> Deep mycoses which<strong> </strong>includes subcutaneous mycoses and systemic mycoses, accounts for about 1% of the all the fungal infections seen in human beings. Though rare, these infections assume significance due to the increased morbidity and mortality associated with them. The objective of the study was to study the incidence, clinical presentation, aetiological agents and histopathological findings of deep mycoses in patients attending the mycology section, department of dermatology of a tertiary centre in Chennai.</p><p class="abstract"><strong>Methods:</strong> All Patients with clinical suspicion of deep mycoses who presented to mycology section during the period from November 2015 to September 2016 were screened. The samples from these patients were subjected to direct microscopy by potassium hydroxide wet mount, culture and histopathology.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among the 8250 patients who attended mycology OPD, 41 patients (0.5%) had deep mycoses. The commonly affected age group was 41-50 yrs (29.7%). Males (73.2%) were predominantly affected. Of the 41 patients, 26.8% were immunocompromised. 37 patients (90.2%) had subcutaneous infection and 4 (9.8%) had opportunistic mycoses. Mycetoma (43.2%) was the most common subcutaneous mycoses. Mucormycosis (75%) and aspergillosis (25%) were the opportunistic mycoses observed. KOH positivity was 100%, while culture positivity was 65.7%. <em>Madurella mycetomatis,</em> <em>Phialophora verrucosa</em>, <em>Rhizopus arrhizus</em> and <em>Aspergillus fumigatus</em> were the common organisms isolated in this study.</p><p class="abstract"><strong>Conclusions:</strong> Mycetoma is the most common subcutaneous mycoses in this part of India. Eumycetoma is more common than actinomycetoma. Phaeohyphomycosis is on the rise. Simple KOH examination would pave way for an early diagnosis and prompt treatment of deep mycoses.</p>

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