Indian Journal of Dermatology
: 2019  |  Volume : 64  |  Issue : 4  |  Page : 330--331

Authors' reply - Antifungal resistance in dermatology

Varadraj Pai1, Ajantha Ganavalli2, KN Naveen3,  
1 Department of Dermatology, Goa Medical College, Goa, India
2 Department of Microbiology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
3 Department of Dermatology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India

Correspondence Address:
Varadraj Pai
Department of Dermatology, Goa Medical College, Goa

How to cite this article:
Pai V, Ganavalli A, Naveen K N. Authors' reply - Antifungal resistance in dermatology.Indian J Dermatol 2019;64:330-331

How to cite this URL:
Pai V, Ganavalli A, Naveen K N. Authors' reply - Antifungal resistance in dermatology. Indian J Dermatol [serial online] 2019 [cited 2022 Aug 9 ];64:330-331
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Full Text


We sincerely appreciate the interest of the author in our review article “Antifungal resistance in dermatology.”[1]

  1. Medical jargon is often described as the second language of healthcare professionals.[2] The authors agree that varied terminologies can add to the existing confusion. They thereby prefer to adhere to the existing nomenclature pending consensus

  2. Clinical resistance is defined as the failure to eradicate a fungal infection despite the administration of an antifungal agent with in vitro activity against the organism. Clinical resistance depends on various host and drug-related factors.[1] A knowledge of distinction between clinical and microbiological resistance is required for various causative factors and their therapeutic outcome.

  3. Ciclopirox olamine is approved as a topical formulation for superficial mycoses. Studies have shown that itraconazole and terbinafine have a lower minimum inhibitory concentration (MIC) than ciclopirox against Trichophyton rubrum and Trichophyton mentagrophytes.[3] Susceptibility tests on Candida albicans revealed a lower MIC for itraconazole and ketoconazole when compared to ciclopirox [4]

  4. Antimicrobial drug resistance is an almost inevitable process that is universal in the microbial world.[1] Ciclopirox also induces change in expression of genes encoding multidrug resistance efflux pumps CDR1 and CDR2.[5] Considering the above facts and the present nature of dermatophytosis, excessive reliance on any single topical medication for therapeutic goals may be unwarranted.

  5. The author highlighted the fungicide usage in agriculture and azole-resistant filamentous fungi in Indian settings.
  6. The main focus of our article remained the mechanism of antifungal resistance in dermatology and broad therapeutic outlines. A comprehensive review of antifungal resistance was beyond the scope of the article.

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Conflicts of interest

There are no conflicts of interest.


1Pai V, Ganavalli A, Kikkeri NN. Antifungal resistance in dermatology. Indian J Dermatol 2018;63:361-8.
2Health Literacy for Interprofessional Education (IPE) eToolkit. Available from: [Last accessed on 2018 Nov 15].
3Singh J, Zaman M, Gupta AK. Evaluation of microdilution and disk diffusion methods for antifungal susceptibility testing of dermatophytes. Med Mycol 2007;45:595-602.
4Danby CS, Boikov D, Rautemaa-Richardson R, Sobel JD. Effect of pH on in vitro susceptibility of Candida glabrata and Candida albicans to 11 antifungal agents and implications for clinical use. Antimicrob Agents Chemother 2012;56:1403-6.
5Lee RE, Liu TT, Barker KS, Lee RE, Rogers PD. Genome-wide expression profiling of the response to ciclopirox olamine in Candida albicans. J Antimicrob Chemother 2005;55:655-62.