Trends in Epidemiology of Dermatophytes in Iran

The epidemiological trends of dermatophyte infections (dermatophytosis or Tinea) in Iran from 1960 to 2018 are characterized here. A thorough search in different literature databases was performed together with statistical analyses. Our findings stress that mycological and clinical aspects of dermatophytosis in Iran have notably been revolutionized over time. Tinea capitis has remained as the dominant Tinea infection in preschool and school-age children throughout the country though its occurrence has markedly subsided after 1980s. In adults, Tinea pedis (22%), Tinea corporis (19.6%), and Tinea cruris (18.4%) were the dominant forms of infection and currently a gradual increase in their incidence is of note. Some clinical types more frequently occurred in some age categories and were caused by some particular species. Tinea capitis more often affected patients under 20 years old, while other Tinea infections were more frequent in middle-aged and older adults. While Trichophyton schoenleinii and Trichophyton violaceum species accounted for a significant part of dermatophytic infections in the past, Epidermophyton floccosum, Trichophyton rubrum, Trichophyton tonsurans, and the Trichophyton mentagrophytes / Trichophyton interdigitale species group are currently predominating in Iran. A more striking mycological aspect of dermatophytosis, however, is the emergence of infection with less-known zoophilic species, e.g. Trichophyton benhamiae, Trichophyton eriotrephon, Trichophyton simii, and Microsporum ferrugineum, all of which having been identified by ITS-rDNA sequencing. Terbinafine, itraconazole, luliconazole, lanoconazole, and efinaconazole showed the best in vitro efficacy against dermatophyte isolates from Iran.