India’s Growing Fungal Skin Infection Crisis: What’s Behind the Surge?

Tinea is a common fungal skin infection that affects the skin, scalp, feet, groin and nails. It is caused by fungi called dermatophytes, which feed on keratin — a protein found in the skin, hair and nails.

Often called ringworm, tinea can cause red, itchy, scaly patches that sometimes form a ring-like pattern. However, not every fungal infection looks the same, and its appearance can change depending on where it develops.

Doctors use different names for tinea depending on the affected area:

• Tinea corporis: Fungal infection on the body, arms or legs.
• Tinea cruris: Infection affecting the groin and inner thighs.
• Tinea capitis: Fungal infection of the scalp and hair.
• Tinea unguium: Fungal infection of the nails.

Several types of fungi can cause these infections, including Trichophyton rubrum and Trichophyton mentagrophytes. In India, another species, Trichophyton indotineae, has become a major concern because many strains are resistant to commonly used antifungal medicines.

This resistance makes some infections difficult to treat and increases the chances of recurrence.

A fungal infection that once responded to routine treatment can now persist for weeks or even months in some patients. One major reason is the widespread and inappropriate use of creams that combine antifungal medicines with corticosteroids.

These combination creams are often used to relieve itching, redness and irritation. The steroid component can make the skin look better within a few days, creating the impression that the infection has disappeared.

But there is a catch: the rash may fade while the fungus continues to survive and spread.

When a cream contains an antifungal in an unsuitable combination or is used incorrectly, the infection may not clear. Repeated use of steroid-containing creams can also alter the appearance of the rash, making diagnosis more difficult.

Another problem is stopping treatment too early. People may discontinue antifungal medication as soon as the itching disappears, even though the infection has not been completely cleared.

Meanwhile, Trichophyton indotineae has added another challenge. Some strains carry genetic mutations that make them resistant to terbinafine, a commonly prescribed oral antifungal. As a result, doctors may need laboratory testing and alternative treatments to manage persistent infections.

An itchy, red patch does not automatically mean you have a fungal infection. Conditions such as eczema, psoriasis and other inflammatory skin disorders can look similar.

Using the wrong cream may delay the correct diagnosis and allow the underlying condition to worsen.

Dermatologists may recommend a potassium hydroxide (KOH) test, in which a small skin scraping is examined under a microscope for signs of fungi. In persistent or treatment-resistant cases, fungal culture and additional testing may help identify the organism and guide treatment.

If a rash continues despite appropriate treatment, returns shortly after treatment stops, or spreads to other parts of the body, consult a dermatologist rather than switching between creams on your own.

Scalp infections deserve particular attention. Tinea capitis often requires oral antifungal medication because topical creams alone cannot adequately reach the infected hair follicles.

The growing problem of antifungal resistance has made accurate diagnosis and appropriate treatment increasingly important.

For uncomplicated infections, a doctor may recommend a topical antifungal. More extensive, recurrent or resistant infections may require oral medication, depending on the affected area, the organism involved and the patient's medical history.

Terbinafine can still work against susceptible fungi. However, when resistance is suspected or confirmed, a dermatologist may consider alternatives such as itraconazole.

These medicines are not interchangeable, and oral antifungals can have significant side effects and drug interactions. The choice of medicine, dose and duration must therefore be determined by a qualified clinician. Some persistent infections require several weeks of treatment and careful follow-up.

The key message is simple: treatment should be based on the infection, not just on how quickly the rash disappears.

Patients should complete the prescribed course and seek medical advice if symptoms persist. They should not extend treatment, increase doses or start oral antifungals without medical supervision.

Antifungal resistance is only one part of the problem. Everyday habits and environmental conditions can also contribute to the spread of fungal infections.

Warm, humid weather encourages fungal growth, while sweat and moisture trapped against the skin can create favourable conditions for infection.

Common risk factors include:

• Sharing towels, clothing or personal grooming items.
• Wearing damp or sweat-soaked clothes for long periods.
• Sharing contaminated sports equipment or other personal items.
• Having close contact with an infected person.
• Living in crowded settings where personal items are frequently shared.

People with diabetes or weakened immune systems may be more vulnerable to severe or persistent infections and should seek medical advice promptly.

If several members of a household develop similar symptoms, each person may need assessment. Treating one individual while others remain infected can contribute to repeated transmission.

Although not every fungal infection can be prevented, a few everyday precautions can help lower the risk of infection and reinfection.

• Keep the skin clean and dry, especially in skin folds and between the toes.
• Change out of sweaty clothes promptly.
• Avoid sharing towels, clothing and personal grooming items.
• Wash clothes and towels regularly, particularly during an active infection.
• Avoid using steroid-containing combination creams without medical advice.
• Seek professional assessment for recurring, widespread or treatment-resistant rashes.

These measures support prevention, but they do not replace appropriate medical treatment once an infection develops.

Tinea may begin as a small, itchy patch, but persistent or resistant infections can become difficult to manage. In India, the spread of antifungal-resistant fungi, inappropriate steroid cream use and incomplete treatment have made the problem more challenging.

The solution is not to try stronger creams or repeatedly change brands. It is to identify the infection correctly, use the appropriate antifungal treatment and follow medical advice for the recommended duration.

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