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As Fungal Infections Rise, Dermatologists Flag Rampant Anti-fungal Resistance

The damp weather and humid conditions after recent rains in Bengaluru have triggered a marked rise in fungal infections. Dermatologists warn that these infections are becoming increasingly difficult to treat due to growing anti-fungal resistance.

Superficial fungal infections such as tinea or ringworm are confined to the outermost layers of the skin, hair, or nails and do not invade deeper tissues or organs.

At ESIC Model Hospital in Rajajinagar, M.S. Girish, Senior Specialist and Head of Dermatology, said fungal infections now account for a significant share of his daily outpatient load. "Of about 120 patients I see in the OPD every day, around 30 come with fungal infections. Every fourth patient I see daily has a fungal infection and nearly 30% of these cases do not respond to basic medication," he said.

Self-medication and resistance

According to Dr. Girish, self-medication and over-the-counter availability of anti-fungal creams are major drivers of resistance. "When used in large quantities or for prolonged durations, the fungus grows resistant. It is similar to anti-microbial resistance," he explained.

He noted that incomplete treatment worsens infections. "Patients stop treatment once symptoms disappear, but relapse is common and often more severe. Some creams have less than the required anti-fungal strength, and repeated use builds resistance, forcing us to opt for advanced treatment," he said.

Raising concerns over steroid-based creams, he said an unacceptable combination of topical steroids with anti-fungals is being used. "Overuse of steroids thins the skin. Itching may reduce temporarily, but this is not a solution," he said.

Rule of Two

To address this, the Indian Association of Dermatologists, Venereologists, and Leprologists (IADVL) has issued a "Rule of Two." Patients are advised to apply antifungal creams twice daily for at least two weeks after visible lesions have resolved, extending the application two centimetres beyond the infected area to ensure complete eradication and prevent recurrence.

Shireen Furtado, Senior Consultant – Medical and Cosmetic Dermatology at Aster CMI Hospital, said she is seeing a steady rise in patients with recurring fungal infections. "Ringworm, athlete's foot, and nail fungus are becoming very common, and many cases are harder to treat than before. The main reason is that the fungus is slowly becoming resistant to the medicines we usually prescribe," she said.

She stressed that misuse of creams and premature stoppage of medication fuel relapses. "Many people buy medicines directly from the pharmacy. Some contain steroids, which give temporary relief but worsen infections. Patients also stop treatment once itching or redness subsides, though the fungus remains and quickly grows back," she explained.

Lifestyle and prevention

Dr. Furtado added that lifestyle factors are also contributing. "The damp and humid climate, sweating, tight clothes, and unhygienic practices add to the rise. Shared spaces like gyms, hostels, and swimming pools make it easy for fungus to spread," she said.

Both doctors emphasised the need for public awareness and responsible use of anti-fungal medicines. Patients should consult a dermatologist instead of self-treating, complete the prescribed course, and follow preventive measures such as keeping skin dry, wearing clean clothes, and not sharing towels.

Published - September 13, 2025 10:31 pm IST

Novel Fungal Skin Infection In U.S. Prompts Vigilance From Dermatologists

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Key takeaways:

The fungal skin infection is caused by T. Mentagrophytes type VII, a dermatophyte.

The infection is found mostly in the genitalia of men who have sex with men.

Dermatologists should be on the lookout for new forms of a highly contagious fungal infection now being reported in the U.S., according to a press release from NYU Langone Health.

In one of two studies published in JAMA Dermatology, researchers from NYU Langone Health documented the first reported case of a sexually transmitted fungal infection presenting as a rare manifestation of dermatophytosis in the U.S.

Dermatologists should be on the lookout for new forms of a highly contagious fungal infection now being reported in the U.S. Image: Adobe Stock.

According to Avrom S. Caplan, MD, assistant professor in the Ronald O. Perelman department of dermatology at NYU Grossman School of Medicine and the study's lead author, the fungal skin manifestation is caused by Trichophyton mentagrophytes type VII which has been referred to in the literature as TMVII. It is a dermatophyte, which is a type of fungus that causes ringworm, jock itch, athlete's foot or tinea capitis. However, this dermatophyte presents itself differently than most forms.

Avrom S. Caplan

"What's different about this particular dermatophyte is the involvement of the genital region," Caplan told Healio. "This is something you don't typically see in a dermatophyte infection."

According to the report of the first case published in JAMA Dermatology, a man in his 30s from New York City developed tinea on his penis, buttocks and limbs after having sex with multiple male partners during his travels throughout Europe. While none of the other men reported similar skin issues, this sexually transmitted form of ringworm has been increasingly diagnosed throughout Europe primarily in men that have sex with men.

"The data are very limited of this particular infection," Caplan explained, "but in some of the reports of this impacted patient population, we are seeing lesions that are a little bit less typical than the common dermatophyte or ringworm infection."

According to the reports, the tinea presented in these patients do not resemble most forms of ringworm but can instead be confused for eczema, causing patients to undergo the wrong type of treatment. Caplan also explained that reports in the literature in France claim the tinea could be inflammatory and could cause abscesses which may lead to infection and scarring.

While a second study led by NYU researchers and published in JAMA Dermatology found presentations of a similar fungal strain, Trichophyton indotineae, that resists standard therapies, Caplan stated that TMVII is treatable.

"There have been a couple of cases where people have changed antifungal therapies, but the data we still have at this point suggest it responds to oral terbinafine," he said.

With this being the first confirmed case of TMVII reaching the U.S., Caplan emphasized that this infection is currently "not an endemic and it is not rapidly spreading," but clinicians should be on the alert for signs and symptoms of the condition.

"The reason we put the report out there is to highlight primarily for clinicians to think about dermatophyte if you're seeing this infection," he said. "Especially if the patient has painful lesions or scaly rashes involving the genitalia, consider this atypical form of ringworm rather than just psoriasis and eczema."

References:

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Fungal Infections In Monsoon: What Causes Them & How To Treat Them Right

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