• The tinea epidemic is more than 5 years old.
• Difficulties in treatment arises due to:

o  Rapidly progressive disease that spreads easily amongst contacts

o  Unusual, highly symptomatic manifestations

o  Poor response to recommend treatments

o  Repeated episodes in spite of apparently successful treatment.

• The need for new guidelines is evident; however, guidelines are only as good as; clear definition of the clinical problem in all its aspects, the rigor of process followed for their generation and the quality of data that is used as their basis.
• Issuing different guidelines for a poor drug quality driven epidemic would be pointless and may be even dangerous.
• Guideline development in India was undergoing transition toward adoption of systematic, transparent and evidence-based approaches but several barriers in the form of attitudes towards use of evidence, lack of methodological capacity, inadequate governance structure and funding exist.
• Treatment guidelines in the absence of MIC breakpoints:

o  There are no defined criteria for labeling dermatophyte strains sensitive or resistant

o  Clinical-lab correlation for antifungal sensitivity studies remains relatively poor

o  A recent expert consensus recommended terbinafine or itraconazole for the initial treatment of tinea corporis.