Prevalence of Squalene Epoxidase Mutation in Terbinafine Resistance: A Systematic Review

Dermatophytosis is a global burden of disease, as it affects around 20-25% of worldwide population.Many antifungal drugs have been developed to treat dermatophytosis that mainly inhibit the ergosterol biosynthesis.Terbinafine as the drug-of-choice has fungicidal effect by inhibiting ergosterol synthesis at the level of squalene epoxidation.Unfortunately, recently many countries reported the emerging terbinafine resistance.However, the exact mechanism of terbinafine resistance is still not clearly understood.Therefore, this paper aimed to provide a systematic literature review that describes the terbinafine resistance via squalene enzyme mutations.We conducted systematic searching to describe the prevalence of squalene enzyme mutation in terbinafine resistance.MEDLINE database was searched with keywords: dermatophytosis, terbinafine, resistance, squalene, mutation.According to our criteria and search protocol, six studies were included that performed squalene enzyme mutation analysis among terbinafine-resistant isolates.Data of those studies were collected to determine a cumulative prevalence of squalene enzyme mutation.According to our systematic review, we found that squalene mutation occurred in 80.39% of terbinafine resistant patients.The consistent finding of squalene enzyme mutation in terbinafine resistance may be seen to provide better strategy in dermatophytosis treatment.Further research may be developed to target another mechanism of anti-mycosis, as well as overcoming the drug resistance to benefit patients with dermatophytosis.