Table 1.

Factors implicated in recalcitrant tinea infections

Inadequate treatment duration with antifungals

Treatment with steroid and over the counter formulations

Treatment irrational combination agents

Local factors—poor hygiene conditions, heat, humidity, occlusive clothing

Ping-pong effect—spread of superficial fungal infections within family members

Barrier function defects—increased TEWL, decreased stratum corneum hydration

Deranged host immune responses.

Compliance

Microbial factors—virulent species

Drug resistance