Br J Dermatol. 2025 Jul 15:ljaf269. doi: 10.1093/bjd/ljaf269. Online ahead of print.
ABSTRACT
BACKGROUND: Chronic recalcitrant dermatophyte infection (CRDI) remains poorly understood, with limited research on its genetic, immunological, and treatment aspects.
OBJECTIVES: To investigate the genetic and immunological profiles, clinical characteristics, and treatment outcomes in otherwise healthy patients with CRDI.
METHODS: A prospective study included patients with isolated superficial dermatophyte infections persisting for over five years and refractory to at least three oral antifungal agents. Whole exome sequencing, interleukin-17 (IL-17) quantification, and lymphocyte subset analysis were performed.
RESULTS: Among 5910 patients with superficial cutaneous fungal infections, 11 patients (90.9% male) with a mean disease duration of 26.4 years (±8.7) were included. All patients presented with extensive dermatophytosis, involving an average of 5.6 (±1.4) skin and nail sites. Immune alterations were identified in 54.5% of the patients, including three with monogenic immunodeficiency mutations (CARD9 and FOXN1), one with acquired immunodeficiency (Good’s syndrome), and two with isolated IL-17 deficiencies. Most patients (n=10/11) showed a partial clinical response to continuous oral antifungal therapy, while only one patient remained complete responder after discontinuing treatment.
CONCLUSIONS: CRDI is a rare condition among patients with superficial cutaneous fungal infections. Genetic and immunological evaluation for immunodeficiency should be considered in CRDI patients. Management may require prolonged or lifelong oral antifungal therapy.
PMID:40663635 | DOI:10.1093/bjd/ljaf269
