Tinea Infections: Changing Face or Neglected?

Dermatophyte infections are of great importance in dermatology practice. The general impression from the literature retrieval is that we are experiencing a change in tinea infections, and these changes involves epidemiology, clinical presentation, diagnosis and therapies. The question is whether dermatophytes are changing their biological attitude or there is a tendency to neglect the diagnosis, because of the common use of topical mixed antibiotic/antimycotic corticosteroid cream, delaying the assessment until no response and evident worsening. Following short review encompass actual knowledge to provide matter of tough and auspicate generation of new studies. The menace of antifungal resistance is worth global alert and address the need of reporting and execution of antifungal sensitity tests, which is not a routinely procedure. The adoption of innovative diagnostic techniques, such as MALDI-TOF and PCR identification are by the way, nevertheless, a trained dermatologist should first of all suspect the infection, even when clinical presentation is not obvious, and possibly perform a simple direct mycological examination after KHO clarification, which rapidly confirms the diagnosis. The use of combined steroidal topical drugs should be avoided, further altering the clinical presentation, sometimes giving the false impression of temporary healing, and favoring patient’s intermittent self-application, with consequent risk of side effects, including skin atrophy. Development of new antifungal and clinical trials realization is a sore point, for the apparently limited interest of pharma industry in respect to the biologics and biosimilars indications. Timing and dosage revisiting of old drugs is the current research topic. Main field of therapeutic interest is implementation of onychomycosis treatment.