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derm.tinea-dermatophytosis.core.v1PRODUCTION
derm.tinea-dermatophytosis.core.v1

Dermatophytosis / tinea (corporis, cruris, pedis, capitis, onychomycosis)

dermatologysubacutechronicadultpediatric
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12/12 authored

Canonical 12-phase frame with authored status for this dossier.

Current phase

Frame

Detailed

Frame as a SITE-DEFINED superficial dermatophyte infection where body site selects both the confirmatory test and the treatment-ladder step. Tinea capitis is ALWAYS systemic. Diagnosis is confirmed mycologically, never assumed — especially before any oral course. The two trap states framed here: tinea incognito (steroid-modified, the commonest mimic trap) and terbinafine-resistant T. indotineae (the emerging-resistance trap).

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site-framed scope set; confirm-before-oral + incognito + T. indotineae traps noted

Patient inputs (16)

Active advancing scaly border with central clearing is the cardinal tinea sign; loss of scale/border = steroid-modified tinea incognito (Wacker Mycoses 2004 PMID 15504132)

Corticosteroid exposure modifies morphology, suppresses antifungal immunity, and is the commonest cause of misdiagnosis as eczema/psoriasis (tinea incognito) (Gallegos Espadas Cureus 2024 PMID 39569254)

Prior antifungal lowers KOH/culture yield and, with recent travel or extensive disease, raises the terbinafine-resistant T. indotineae prior (Gupta JEADV 2025 PMID 40613321; Gupta Am J Clin Dermatol 2023 PMID 37553539)

Site (glabrous skin vs foot vs groin vs scalp/hair vs nail) is the master variable that selects the diagnostic test and the entire treatment ladder step (El-Gohary Cochrane 2014 PMID 25090020; Chen JAAD 2016 PMID 27816294)

First-line, rapid, high-sensitivity confirmation (~90% in nail series) — confirm BEFORE oral therapy especially for nail/scalp/incognito (Villanueva-Reyes 2026 PMID 41793813)

Extensive disease, follicular pustules, or Majocchi granuloma cannot be cleared by topicals and mandates oral therapy (Gupta JEADV 2018 PMID 29797669)

Tinea capitis is overwhelmingly pediatric and needs weight-based systemic dosing; nail/oral-azole DDIs cluster in the polypharmacy elderly (Chen JAAD 2016 PMID 27816294)

HIV/transplant/biologic immunosuppression → extensive, deep (Majocchi), atypical disease needing oral therapy + lower confirm threshold (Gupta JEADV 2025 PMID 40613321)

Tinea pedis / onychomycosis is the modifiable cellulitis portal of entry in diabetes — route to derm.cellulitis.core.v1 and prioritise eradication (cellulitis portal evidence)

Species identification (Trichophyton vs Microsporum drives capitis drug; PCR sens ~93% vs culture) + the only way to flag T. indotineae for susceptibility testing (Cuchí-Burgos 2021 PMID 34353508; Gupta JEADV 2025 PMID 40613321)

Baseline ± on-treatment hepatic monitoring for prolonged oral terbinafine/azole/griseofulvin courses (Gupta JEADV 2006 PMID 17062029)

Baseline before prolonged oral antifungal (rare terbinafine cytopenia; griseofulvin) and pre-immunosuppression context (Chen JAAD 2016 PMID 27816294)

Griseofulvin teratogenic / azoles teratogenic / oral terbinafine generally avoided — topical-only is preferred in pregnancy and gates the oral ladder (El-Gohary Cochrane 2014 PMID 25090020)

Oral terbinafine and azoles are hepatotoxic — significant hepatic disease contraindicates or modifies the oral ladder (Gupta JEADV 2006 PMID 17062029)

Itraconazole is a strong CYP3A4 inhibitor (statins, DOACs, many others) — drug-interaction screen gates azole selection (Gupta JEADV 2025 PMID 40613321)

CKD-EPI 2021 race-free eGFR for fluconazole renal dose-adjustment and oral-antifungal safety in CKD (Inker NEJM 2021)

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Severity triggers (6)

6 need judgement
  • informationalseveretinea_capitis_kerion
    Boggy, tender, inflammatory scalp mass ± purulent discharge, pustules, occipital/cervical lymphadenopathy in a child with tinea capitis
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderatetinea_incognito_steroid_modified
    Atypical, ill-defined, scale-poor, recurrent or treatment-resistant rash after topical/systemic corticosteroid — improves then rebounds wider (steroid-modified tinea)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderatet_indotineae_terbinafine_resistant
    Extensive/recalcitrant tinea, terbinafine treatment failure, prior antifungal use, or recent travel to/contact from an endemic region — suspected terbinafine-resistant Trichophyton indotineae
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderateimmunocompromised_extensive_or_majocchi
    HIV/transplant/biologic-immunosuppressed host with extensive, deep follicular (Majocchi granuloma) or atypical widespread dermatophytosis
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderatetinea_pedis_cellulitis_portal_in_diabetes
    Interdigital tinea pedis / fissuring / onychomycosis in a diabetic or vasculopath — the modifiable lower-limb cellulitis portal of entry
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmildwidespread_or_treatment_resistant_reconfirm_dx
    Widespread, recurrent, or treatment-resistant dermatophytosis not improving on an adequate appropriate course
    Trigger could not be auto-evaluated — needs clinician judgement.

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Recommended regimen

Dermatophytosis — site-stepwise topical→oral ladder (Cochrane topical 2014 / Cochrane capitis 2016 / onychomycosis RCTs / T. indotineae stewardship 2025)
axis: tinea_site_stepwise_ladderstep 1 - Step 1 — Localized glabrous tinea (corporis / cruris / pedis): topical antifungal
Selected step "Step 1 — Localized glabrous tinea (corporis / cruris / pedis): topical antifungal" — Limited-BSA tinea corporis/cruris/pedis, immunocompetent, no follicular/Majocchi/nail/scalp involvement, no steroid-modified atypia
  • terbinafine
    first line
    topical_allylamine
    1% cream/gel/solution • topical • once–twice daily (max: tinea corporis/cruris ~1–2 wk; interdigital pedis ~1–4 wk; moccasin pedis longer)
    triggers: localized_tinea_corporis, tinea_cruris, tinea_pedis
    El-Gohary Cochrane 2014 (PMID 25090020) — topical terbinafine highest clinical-cure signal vs placebo (RR 4.51, 95% CI 3.10–6.56, NNT 3); fungicidal allylamine, shorter courses than azoles.
    rxcui 37801
  • naftifine
    first line
    topical_allylamine
    1–2% cream/gel • topical • once daily (max: ~2–4 wk)
    triggers: localized_glabrous_tinea, allylamine_preferred
    El-Gohary Cochrane 2014 (PMID 25090020) — naftifine 1% mycologic cure favoured vs placebo (RR 2.38, 95% CI 1.80–3.14, NNT 3); anti-inflammatory allylamine.
    rxcui 31476
  • clotrimazole
    first line
    topical_azole
    1% cream • topical • BID (max: ~2–4 wk)
    triggers: localized_glabrous_tinea, azole_preferred
    El-Gohary Cochrane 2014 (PMID 25090020) — clotrimazole 1% mycologic cure vs placebo RR 2.87 (95% CI 2.28–3.62, NNT 2); broad azole option.
    rxcui 2623
  • ketoconazole
    first line
    topical_azole
    2% cream • topical • once–twice daily (max: ~2–4 wk)
    triggers: localized_glabrous_tinea, tinea_cruris
    El-Gohary Cochrane 2014 (PMID 25090020) — topical azoles broadly effective with no class superiority over benzylamines; ketoconazole well suited to cruris.
    rxcui 6135
  • miconazole
    first line
    topical_azole
    2% cream/powder • topical • BID (max: ~2–4 wk)
    triggers: localized_glabrous_tinea, tinea_pedis
    El-Gohary Cochrane 2014 (PMID 25090020) — established azole; powder formulation aids interdigital tinea pedis + reservoir control.
    rxcui 6932
  • ciclopirox
    second line
    topical_hydroxypyridone
    0.77% cream/gel • topical • BID (max: ~4 wk)
    triggers: azole_allylamine_intolerance, mixed_yeast_dermatophyte
    El-Gohary Cochrane 2014 (PMID 25090020) — broad-spectrum non-azole/allylamine alternative; also a topical-onychomycosis agent (see Step 4).
    rxcui 21090
  • avoid_topical_combination_corticosteroid_antifungal
    contraindication substitute
    deprescribing_rule
    triggers: otc_steroid_antifungal_combo_use, risk_of_tinea_incognito
    Wacker Mycoses 2004 (PMID 15504132); El-Gohary Cochrane 2014 (PMID 25090020 — combination steroid-antifungal creams not recommended in guidelines) — combination creams breed tinea incognito and resistance; use single-agent antifungal.

outpatient playbook — drug actions (4)

  1. 1. topical terbinafine 1% (localized glabrous tinea corporis/cruris/pedis)
    rxcui 37801
    1% • topical • once–twice daily ~2–4 wk
    trigger: Limited-BSA immunocompetent glabrous tinea (El-Gohary Cochrane 2014 PMID 25090020)
    Highest topical clinical-cure signal (RR 4.51 vs placebo, NNT 3); fungicidal allylamine
  2. 2. oral terbinafine 250 mg daily (extensive/Majocchi/incognito/immunocompromised — stop steroid first if incognito)
    rxcui 37801
    250 mg • PO • once daily 2–4 wk
    trigger: Extensive/follicular/steroid-modified/immunocompromised glabrous disease, no T. indotineae suspicion (Gupta JEADV 2018 PMID 29797669)
    Systemic clearance where topical inadequate; switch to itraconazole if T. indotineae suspected
  3. 3. tinea capitis ALWAYS systemic: terbinafine (Trichophyton) OR griseofulvin (Microsporum) weight-based + sporicidal shampoo + treat contacts/fomites
    rxcui 5021
    weight-based • PO • 4–8 wk
    trigger: Any tinea capitis — topical never adequate; species directs drug (Chen JAAD/Cochrane 2016 PMID 27816294)
    Terbinafine better for T. tonsurans (RR 1.47); griseofulvin better for M. canis (RR 0.68)
  4. 4. onychomycosis (confirm first): oral terbinafine continuous/pulse OR itraconazole pulse + eradicate tinea-pedis reservoir
    rxcui 37801
    250 mg • PO • toenail ~12 wk
    trigger: Mycologically confirmed dermatophyte onychomycosis (Gupta JEADV 2006 PMID 17062029)
    Terbinafine mycologic cure ~79%, itraconazole pulse ~88% (NS); counsel slow nail outgrowth

Auto-drafted A&P note

outpatient

Subjective

- Possible entry pathways: Annular/arciform scaly plaque with an active advancing scaly border and central clearing (tinea corporis/cruris; El-Gohary Cochrane 2014 PMID 25090020); Interdigital maceration/fissuring or moccasin-distribution hyperkeratotic plantar scale ± vesicles (tinea pedis; Cochrane topical evidence PMID 25090020); Scaly scalp patch with broken hairs / black dots / kerion in a child → tinea capitis entry — ALWAYS systemic (Chen JAAD/Cochrane 2016 PMID 27816294).

Objective

- No vitals, labs, or imaging entered for this encounter.

Assessment

**Dermatophytosis / tinea (corporis, cruris, pedis, capitis, onychomycosis)** (derm.tinea-dermatophytosis.core.v1).
Phenotype framing: Terminal differential with named pivots: tinea corporis vs nummular eczema/AD (KOH+ + advancing scaly annular border with central clearing pivot; route derm.atopic-dermatitis.core.v1) vs psoriasis (sharp salmon plaque + silver scale + nail pits pivot; route derm.psoriasis.core.v1) vs pityriasis rosea (herald patch + collarette + Christmas-tree, KOH− pivot) vs granuloma annulare (no scale, dermal, KOH− pivot) vs erythema migrans (expanding non-scaly, tick exposure pivot) vs candidal intertrigo (satellite pustules, moist, KOH yeast/pseudohyphae pivot) vs seborrheic dermatitis (greasy scale, central-face/scalp pivot); tinea capitis vs alopecia areata (smooth, exclamation hairs, KOH− pivot) / seborrheic / psoriasis; onychomycosis vs psoriatic nail (pitting + oil-drop + skin psoriasis pivot) vs lichen planus (pterygium + longitudinal ridging pivot) vs traumatic dystrophy (single great-toe, history pivot). Steroid-response-worsens favours occult tinea (incognito).
Scope: Frame as a SITE-DEFINED superficial dermatophyte infection where body site selects both the confirmatory test and the treatment-ladder step. Tinea capitis is ALWAYS systemic. Diagnosis is confirmed mycologically, never assumed — especially before any oral course. The two trap states framed here: tinea incognito (steroid-modified, the commonest mimic trap) and terbinafine-resistant T. indotineae (the emerging-resistance trap).

No severity triggers fired against current inputs.

Plan

Regimen axis: **Dermatophytosis — site-stepwise topical→oral ladder (Cochrane topical 2014 / Cochrane capitis 2016 / onychomycosis RCTs / T. indotineae stewardship 2025)** — step "Step 1 — Localized glabrous tinea (corporis / cruris / pedis): topical antifungal".
1. terbinafine 1% cream/gel/solution topical once–twice daily (topical_allylamine, first line) — El-Gohary Cochrane 2014 (PMID 25090020) — topical terbinafine highest clinical-cure signal vs placebo (RR 4.51, 95% CI 3.10–6.56, NNT 3); fungicidal allylamine, shorter courses than azoles.
2. naftifine 1–2% cream/gel topical once daily (topical_allylamine, first line) — El-Gohary Cochrane 2014 (PMID 25090020) — naftifine 1% mycologic cure favoured vs placebo (RR 2.38, 95% CI 1.80–3.14, NNT 3); anti-inflammatory allylamine.
3. clotrimazole 1% cream topical BID (topical_azole, first line) — El-Gohary Cochrane 2014 (PMID 25090020) — clotrimazole 1% mycologic cure vs placebo RR 2.87 (95% CI 2.28–3.62, NNT 2); broad azole option.
4. ketoconazole 2% cream topical once–twice daily (topical_azole, first line) — El-Gohary Cochrane 2014 (PMID 25090020) — topical azoles broadly effective with no class superiority over benzylamines; ketoconazole well suited to cruris.
5. miconazole 2% cream/powder topical BID (topical_azole, first line) — El-Gohary Cochrane 2014 (PMID 25090020) — established azole; powder formulation aids interdigital tinea pedis + reservoir control.
6. ciclopirox 0.77% cream/gel topical BID (topical_hydroxypyridone, second line) — El-Gohary Cochrane 2014 (PMID 25090020) — broad-spectrum non-azole/allylamine alternative; also a topical-onychomycosis agent (see Step 4).
7. avoid_topical_combination_corticosteroid_antifungal (deprescribing_rule, contraindication substitute) — Wacker Mycoses 2004 (PMID 15504132); El-Gohary Cochrane 2014 (PMID 25090020 — combination steroid-antifungal creams not recommended in guidelines) — combination creams breed tinea incognito and resistance; use single-agent antifungal.

Setting playbook (outpatient) — Confirm the dermatophytosis mycologically by site (KOH ± culture/PCR ± PAS), exclude the eczema/psoriasis/incognito mimics, select the site-appropriate ladder step (topical glabrous / oral extensive / always-systemic scalp / confirm-first nail), apply the terbinafine-resistant T. indotineae branch when failure or travel-linked, and control the reservoir/fomites (El-Gohary Cochrane 2014 PMID 25090020; Chen JAAD/Cochrane 2016 PMID 27816294; Gupta JEADV 2025 PMID 40613321)
8. topical terbinafine 1% (localized glabrous tinea corporis/cruris/pedis) 1% topical once–twice daily ~2–4 wk — Limited-BSA immunocompetent glabrous tinea (El-Gohary Cochrane 2014 PMID 25090020) (Highest topical clinical-cure signal (RR 4.51 vs placebo, NNT 3); fungicidal allylamine)
9. oral terbinafine 250 mg daily (extensive/Majocchi/incognito/immunocompromised — stop steroid first if incognito) 250 mg PO once daily 2–4 wk — Extensive/follicular/steroid-modified/immunocompromised glabrous disease, no T. indotineae suspicion (Gupta JEADV 2018 PMID 29797669) (Systemic clearance where topical inadequate; switch to itraconazole if T. indotineae suspected)
10. tinea capitis ALWAYS systemic: terbinafine (Trichophyton) OR griseofulvin (Microsporum) weight-based + sporicidal shampoo + treat contacts/fomites weight-based PO 4–8 wk — Any tinea capitis — topical never adequate; species directs drug (Chen JAAD/Cochrane 2016 PMID 27816294) (Terbinafine better for T. tonsurans (RR 1.47); griseofulvin better for M. canis (RR 0.68))
11. onychomycosis (confirm first): oral terbinafine continuous/pulse OR itraconazole pulse + eradicate tinea-pedis reservoir 250 mg PO toenail ~12 wk — Mycologically confirmed dermatophyte onychomycosis (Gupta JEADV 2006 PMID 17062029) (Terbinafine mycologic cure ~79%, itraconazole pulse ~88% (NS); counsel slow nail outgrowth)

Non-pharmacologic actions:
- KOH microscopy at point of care; fungal culture / dermatophyte PCR for nail, scalp (species), and any resistance-suspect case (Cuchí-Burgos 2021 PMID 34353508)
- STOP topical/systemic corticosteroid and re-sample if tinea incognito suspected; never combination steroid-antifungal creams (Wacker Mycoses 2004 PMID 15504132)
- Treat household contacts + decontaminate fomites (combs, hats, towels; consider pets for M. canis) for tinea capitis (Gupta JEADV 2018 PMID 29797669)
- Footwear/hosiery hygiene + antifungal foot powder + treat tinea pedis as the onychomycosis/cellulitis reservoir (recurrence prevention)
- Antifungal stewardship counselling and culture+susceptibility for suspected/confirmed terbinafine-resistant T. indotineae (Gupta JEADV 2025 PMID 40613321)

AVOID / contraindication checks:
- Griseofulvin contraindicated in pregnancy teratogenic and avoid conception window (Chen JAAD/Cochrane 2016 PMID 27816294 — topical only in pregnancy)
- Azoles itraconazole fluconazole teratogenic avoid in pregnancy (El Gohary Cochrane 2014 PMID 25090020 — topical antifungal preferred in pregnancy/lactation)
- Oral terbinafine generally avoided in pregnancy and in significant hepatic or renal disease (Gupta JEADV 2006 PMID 17062029 — hepatotoxicity; rare cytopenia/taste loss)
- Itraconazole strong cyp3a4 inhibitor screen statins DOACs and other interacting comeds (Gupta JEADV 2025 PMID 40613321 — DDI gate before azole selection)
- Itraconazole negative inotrope caution in heart failure (label class caution)
- Confirm onychomycosis and tinea capitis mycologically before committing to months of oral therapy (Villanueva Reyes 2026 PMID 41793813)
- Do not empiric terbinafine monotherapy when T indotineae suspected stewardship (Gupta JEADV 2025 PMID 40613321)
- Avoid OTC combination corticosteroid antifungal creams breed tinea incognito (Wacker Mycoses 2004 PMID 15504132)

Monitoring

Regimen monitoring:
- clinical plus mycologic cure repeat KOH culture at end of course (Villanueva-Reyes 2026 PMID 41793813)
- onychomycosis nail outgrowth lags clinically ~9-12mo slow outgrowth is expected not early failure (Gupta JEADV 2006 PMID 17062029)
- tinea capitis clinical plus mycologic clearance reassess ~4-8wk treat to mycologic cure (Chen JAAD/Cochrane 2016 PMID 27816294)
- LFT baseline and on-treatment for prolonged oral terbinafine azole griseofulvin (Gupta JEADV 2006 PMID 17062029)
- itraconazole ongoing CYP3A4 DDI surveillance (Gupta JEADV 2025 PMID 40613321)
- non response or relapse reconfirm dx reassess reservoir adherence and consider T indotineae susceptibility (Gupta Am J Clin Dermatol 2023 PMID 37553539)

Setting (outpatient) monitoring:
- Clinical + mycologic cure (repeat KOH/culture) at end of the site-appropriate course (Villanueva-Reyes 2026 PMID 41793813)
- Onychomycosis: expect ~9–12 mo nail outgrowth lag — slow outgrowth is not early failure (Gupta JEADV 2006 PMID 17062029)
- LFT for prolonged oral terbinafine/azole/griseofulvin; ongoing itraconazole CYP3A4 DDI surveillance (Gupta JEADV 2025 PMID 40613321)

Follow-up plan: Recurrence prevention + reservoir control: footwear/hosiery hygiene, antifungal foot powder, treat tinea pedis as the onychomycosis + cellulitis reservoir, household/fomite treatment and screening for tinea capitis (combs, hats, pets for M. canis), athlete/communal-shower precautions, occupational counselling. Onychomycosis relapse-prevention with intermittent topical maintenance and pedis eradication. Confirmed T. indotineae → antifungal stewardship counselling (no empiric terbinafine monotherapy, avoid OTC combination steroid-antifungal creams that breed incognito) and dermatology continuity.
- Close-out criterion: reservoir + fomite + recurrence-prevention plan documented; stewardship counselling given; derm continuity arranged

Monitoring phase: Disease: clinical + mycologic cure (repeat KOH/culture) at end of course — onychomycosis cure lags clinical outgrowth by months (slow nail growth is EXPECTED, not early failure; toenail clear-out ~9-12 mo). Tinea capitis: clinical + mycologic clearance at ~4-8 wk, treat to mycologic cure. Drug safety: LFT for prolonged oral terbinafine/azole/griseofulvin per duration/symptoms; itraconazole CYP3A4 DDIs ongoing. Non-response or relapse → reconfirm diagnosis, reassess adherence/reservoir, and consider terbinafine-resistant T. indotineae with susceptibility testing.

Disposition

Current setting: outpatient — Confirm the dermatophytosis mycologically by site (KOH ± culture/PCR ± PAS), exclude the eczema/psoriasis/incognito mimics, select the site-appropriate ladder step (topical glabrous / oral extensive / always-systemic scalp / confirm-first nail), apply the terbinafine-resistant T. indotineae branch when failure or travel-linked, and control the reservoir/fomites (El-Gohary Cochrane 2014 PMID 25090020; Chen JAAD/Cochrane 2016 PMID 27816294; Gupta JEADV 2025 PMID 40613321)

Disposition criteria:
- Entirely outpatient — continue the site-appropriate ladder + reservoir/fomite control + dermatology continuity (no admission pathway)
- Confirmed T. indotineae → antifungal stewardship + public-health awareness/notification + dermatology continuity (Gupta JEADV 2025 PMID 40613321)
- Route eczematous/psoriasiform mimics and the diabetic cellulitis portal OUT by engine_id

Escalation triggers (move to higher acuity):
- Tinea capitis kerion (boggy inflammatory mass) → continue systemic + consider short adjunctive corticosteroid; scarring-alopecia risk (Chen JAAD/Cochrane 2016 PMID 27816294)
- Treatment failure / relapse / recent travel + extensive disease → suspect terbinafine-resistant T. indotineae → culture + susceptibility + higher-dose longer itraconazole + stewardship (Gupta JEADV 2025 PMID 40613321)
- Tinea pedis as a cellulitis portal in a diabetic / vasculopath → route derm.cellulitis.core.v1 and prioritise eradication

Earlier-Return Triggers

Return-precaution thresholds (watch for):
- [SEVERE] Boggy, tender, inflammatory scalp mass ± purulent discharge, pustules, occipital/cervical lymphadenopathy in a child with tinea capitis
- [MODERATE] Atypical, ill-defined, scale-poor, recurrent or treatment-resistant rash after topical/systemic corticosteroid — improves then rebounds wider (steroid-modified tinea)
- [MODERATE] Extensive/recalcitrant tinea, terbinafine treatment failure, prior antifungal use, or recent travel to/contact from an endemic region — suspected terbinafine-resistant Trichophyton indotineae

Citations

- Dermatophytosis evidence chain (PubMed-verified 2026-05-18): T. indotineae & terbinafine resistance — Gupta et al, JEADV 2025 scoping review + stewardship (PMID 40613321); Gupta et al, Am J Clin Dermatol 2023 North-American AFST/MIC management (PMID 37553539); Gupta et al, Expert Rev Anti Infect Ther 2024 (PMID 39114868); Gupta et al, Antibiotics 2025 SQLE mutations (PMID 40426539); Jabet et al, Emerg Infect Dis 2022 France series (PMID 34932456); Sonego et al, J Clin Med 2024 treatment options (PMID 38930086). Tinea capitis — Chen et al, JAAD abridged Cochrane 2016 (PMID 27816294); González et al, Cochrane 2007 (PMID 17943825); Gupta et al, JEADV 2018 systematic review (PMID 29797669). Onychomycosis — Gupta et al, JEADV 2006 RCT (PMID 17062029); Pajaziti & Vasili, Med Arch 2015 RCT (PMID 26261386). Glabrous-tinea topicals — El-Gohary et al, Cochrane 2014 (PMID 25090020); van Zuuren et al, BJD 2015 summary (PMID 25294700). Diagnostics — Cuchí-Burgos et al, 2021 qPCR (PMID 34353508); Villanueva-Reyes et al, Diagn Microbiol Infect Dis 2026 (PMID 41793813). Tinea incognito — Gallegos Espadas et al, Cureus 2024 (PMID 39569254); Wacker et al, Mycoses 2004 (PMID 15504132) [PMID:40613321](https://pubmed.ncbi.nlm.nih.gov/40613321/)
- Cited evidence (PMID 37553539) [PMID:37553539](https://pubmed.ncbi.nlm.nih.gov/37553539/)
- Cited evidence (PMID 39114868) [PMID:39114868](https://pubmed.ncbi.nlm.nih.gov/39114868/)
- Cited evidence (PMID 34932456) [PMID:34932456](https://pubmed.ncbi.nlm.nih.gov/34932456/)
- Cited evidence (PMID 27816294) [PMID:27816294](https://pubmed.ncbi.nlm.nih.gov/27816294/)

Last reconciled with current guidelines: 2026-05-22.
References
  • Dermatophytosis evidence chain (PubMed-verified 2026-05-18): T. indotineae & terbinafine resistance — Gupta et al, JEADV 2025 scoping review + stewardship (PMID 40613321); Gupta et al, Am J Clin Dermatol 2023 North-American AFST/MIC management (PMID 37553539); Gupta et al, Expert Rev Anti Infect Ther 2024 (PMID 39114868); Gupta et al, Antibiotics 2025 SQLE mutations (PMID 40426539); Jabet et al, Emerg Infect Dis 2022 France series (PMID 34932456); Sonego et al, J Clin Med 2024 treatment options (PMID 38930086). Tinea capitis — Chen et al, JAAD abridged Cochrane 2016 (PMID 27816294); González et al, Cochrane 2007 (PMID 17943825); Gupta et al, JEADV 2018 systematic review (PMID 29797669). Onychomycosis — Gupta et al, JEADV 2006 RCT (PMID 17062029); Pajaziti & Vasili, Med Arch 2015 RCT (PMID 26261386). Glabrous-tinea topicals — El-Gohary et al, Cochrane 2014 (PMID 25090020); van Zuuren et al, BJD 2015 summary (PMID 25294700). Diagnostics — Cuchí-Burgos et al, 2021 qPCR (PMID 34353508); Villanueva-Reyes et al, Diagn Microbiol Infect Dis 2026 (PMID 41793813). Tinea incognito — Gallegos Espadas et al, Cureus 2024 (PMID 39569254); Wacker et al, Mycoses 2004 (PMID 15504132) — PMID:40613321
  • Cited evidence (PMID 37553539) — PMID:37553539
  • Cited evidence (PMID 39114868) — PMID:39114868
  • Cited evidence (PMID 34932456) — PMID:34932456
  • Cited evidence (PMID 27816294) — PMID:27816294