Consensus recommendations for Trichophyton indotineae: A modified Delphi study
In brief
Experts reached consensus on 81% of recommendations for resistant ringworm fungus
In a four-round Delphi study, 19 to 20 experts agreed on 34 of 42 recommendations for diagnosing and treating Trichophyton indotineae, a fungus often resistant to terbinafine. They recommend confirming the species with molecular testing and using oral itraconazole for 6 to 8 weeks; posaconazole is a salvage option after failure. These are interim recommendations, and trials are needed to establish the best regimens.
- Journal
- Journal of the European Academy of Dermatology and Venereology : JEADV (Q1)
- Published
- 25 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Aditya K Gupta, Mesbah Talukder, Ditte Marie L Saunte, Roderick James Hay, Michael Arabatzis, Avrom S Caplan, et al.
- PMID
- 42786909
- DOI
- 10.1111/jdv.70731
Why clinicians should know about it
- Picked for Dermatology (top studies of the week, 27 September 2026): Consensus Delphi, practical guidance for resistant dermatophyte infection
- Picked for Histology (top studies of the week, 27 September 2026): Consensus on fungal diagnosis, not histology
Abstract
BACKGROUND: Trichophyton indotineae (T. mentagrophytes genotype VIII) is spreading globally and is often terbinafine resistant. Guidance for diagnosis and treatment remains inconsistent. METHODS: We performed a four-round modified Delphi study. A steering group developed a literature-informed, 42-item questionnaire on diagnosis and management. Consensus was predefined as ≥70% agreement. RESULTS: Thirty-four experts were invited; 20 completed rounds 1 and 2 and 19 completed rounds 3 and 4. Consensus was achieved for 34/42 items (80.95%). The panel advised suspecting T. indotineae infection in patients with extensive or terbinafine-recalcitrant dermatophytosis, particularly those with a history of travel to or residence in endemic regions. For diagnosis, the panel recommended KOH direct microscopy and fungal culture for suspected dermatophyte infection, and PCR (polymerase chain reaction) with species-level discrimination or ITS sequencing for confirmation of T. indotineae. For resistance assessment, SQLE sequencing and antifungal susceptibility testing were preferred where available, particularly after treatment failure. For treating superficial fungal infections caused by T. indotineae, experts recommended oral itraconazole therapy (100-200 mg/day for 6-8 weeks, or longer as clinically indicated), with luliconazole 1% cream as the preferred adjunctive topical option. Oral posaconazole (300 mg/day for 4-12 weeks) can be considered as the salvage therapy following itraconazole failure, keeping in mind antifungal stewardship. CONCLUSIONS: These consensus statements provide practical interim recommendations. Randomized controlled trials are needed to validate outcomes and optimize regimens.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.