Recalcitrant dermatophytosis due to Trichophyton indotineae: A case series from Sarawak, Malaysia

The development of terbinafine-resistant <i>Trichophyton indotineae</i> has made the treatment of dermatophytosis a challenging task globally. We herein report three recalcitrant tinea infections in Sarawak, Malaysia. The ITS sequencing and phylogenetic analysis have confirmed <i>T. indotineae</i>. Furthermore, all isolates carried the Leu393Ser mutation in the <i>SQLE</i> gene, and associated with high terbinafine MICs. However, the voriconazole and itraconazole susceptibilities were variable. The successful azole therapy guided by susceptibility testing (voriconazole/itraconazole) had achieved clinical resolution in one case.