The Changing Face of Dermatophytosis: A Call for Surveillance and Stewardship in Pakistan

Abstract

Dermatophytosis is evolving from a predictable superficial infection into a challenging clinical problem due to antifungal resistance, especially the emergence and global dissemination of Trichophyton indotineae. Pakistan is not exempted from this emerging threat. Recent laboratory-based evidence from Karachi has isolated T. indotineae and terbinafine-non-wild-type Trichophyton isolates among patients with recalcitrant dermatophytosis, although these findings cannot estimate national prevalence. This editorial highlights the need to interpret these findings as an early warning sign that requires systematic surveillance. The potential contributors to treatment failure include inappropriate antifungal exposure, use of corticosteroid-containing combinations, diagnostic limitations and inappropriate treatment practices. Given the challenges of nationwide surveillance, a proportionate approach based on sentinel dermatology and mycology centres, strengthened laboratory capacity and standardized reporting is proposed. Antifungal stewardship should focus on accurate diagnosis, rational prescribing and timely investigation of recalcitrant disease. Pakistan-specific clinical guidance should evolve. The Journal of Pakistan Association of Dermatologists (JPAD) can act as platform for multicentre research, standardized reporting, consensus recommendations, education and multidisciplinary collaboration to translate emerging evidence into action.