Humid subtropical weather condition of District Abbottabad promotes fungal proliferation; hence, dermatomycoses are a growing public health problem in Pakistan. While there is regional molecular epidemiological data and knowledge of socio-demographic drivers is limited, there is a high clinical burden. The aim of this study was to find out the prevalence, clinical spectrum and molecular profile of fungal skin infections in Abbottabad through polyphasic diagnosis. A descriptive cross-sectional study was carried out in 350 cases clinically suspected. A triangulated approach was used for diagnostic confirmation: KOH microscopy, phenotypic culture on Sabouraud Dextrose Agar (SDA) and molecular identification using PCR-Sanger sequencing of the Internal Transcribed Spacer (ITS) region. Multivariate binary logistic regression was used to determine independent predictor(s) of infection. Laboratory confirmation of fungal etiology was made in 77.1% (n=270) cases. The highest prevalence was for Trichophyton rubrum (25.7%) followed by the Trichophyton mentagrophytes/T. indotineae complex (20.0%) and zoonotic Microsporum canis (11.4%). The most common clinical presentation was tinea corporis (34.3%). Multivariate analysis revealed that illiteracy (aOR 11.0; 95% CI 4.84–25.02), low income (aOR 8.50; 95% CI 3.92–18.43), and young adult age (aOR 4.15) were potent independent predictors of infection (p < 0.05). Representative sequences were lodged in GenBank (PQ852143 - PQ852145). The study highlights the high burden of dermatophytosis within the region, especially in terms of socioeconomic differences, and the rise in potentially recalcitrant species. The study underscores the clinical need of conducting regular molecular diagnostics and the need for a "One Health" surveillance plan to curb the dissemination of multidrug-resistant fungal pathogens in Pakistan.

Keywords: Dermatomycosis, Molecular Epidemiology, ITS-PCR, Zoonotic Transmission, Abbottabad.