In a new interview conducted on-site at the Dermatology Education Foundation (DERM) 2025 NP/PA CME Conference, Adam Friedman, MD, spoke with the HCPLive editorial team about managing tinea, also known as dermatophytosis.
Friedman, who serves as Professor, Chair of Dermatology, Residency Program Director, Director of Translational Research, and Director of the Supportive Oncodermatology Program in the George Washington University School of Medicine & Health, emphasized the importance of recognizing and treating dermatophytosis, a common but often overlooked group of fungal skin infections, due to the risk of anti-fungal resistance.
“Dermatophytosis, which encompasses a wide array of clinical cutaneous infections associated with dermatophyte infections, is super common, but is not commonly discussed because it just isn’t ‘sexy,’” Friedman said. “And I get it, who wants to talk about fungal infections? But we can’t put our heads in the sand. We need to be able to make the right diagnosis, but also consider the potential for anti-fungal resistance if we don’t treat the right thing, or if we’re not thoughtful about how we use our anti-fungals, of which we unfortunately don’t have a huge amount.”
Friedman stressed that clinical inspection alone is insufficient for diagnosis, advocating for the use of potassium hydroxide preps, scrapings, cultures, and biopsies to accurately identify and treat fungal infections.
“I know we pride ourselves as master diagnosticians, but we have proven time and again in the published literature that clinical inspection is not enough,” Friedman explained. “Use my favorite tool of all time, your potassium hydroxide prep. I realize there are some limitations with CLIA certification, but this very simple tool can be the distinguisher between calling something a dermatophyte infection or something primary inflammatory. By defining the disease, you can purposely select the correct treatment regimen, which will then make your patient happy and will prevent fungi from developing resistance to the limited things we have.”
Friedman went on to warn about of the growing resistance to antifungals, particularly azole anti-fungals like econazole and fluconazole. He noted the necessity for careful anti-fungal stewardship, similar to antibacterial stewardship, given the limited number of new anti-fungal treatments available.
“When we think about our anti-fungal armamentarium, most of them are what are called static,” Friedman said. “They are inhibiting an enzyme or something that’s needed for cell survival. And when you are inhibiting one thing, the problem is, the fungus among us can become kind of clever and pivot. That, in essence, is where resistance occurs, where one surviving cell has managed to shift the narrative and utilize other machinery to survive. And then it passes that information through its friends…and then we have an anti-fungal that’s rendered useless.”
To find out additional information on the subjects covered by Friedman in his session on tinea, view his full video interview posted above. For more on related information, view our latest DERM 2025 coverage.
The quotes contained in this interview description were edited for clarity.
Friedman has previously reported serving as a consultant to Dermira, Eli Lilly and Company, Encore Dermatology Inc, Exeltis, Galderma, IntraDerm, Johnson and Johnson, Oculus Innovative Sciences, Pfizer Inc, and Sanovaworks.