Chronic dermatophytosis: A clinical, epidemiological, mycological study

Background: Dermatophytes are a common cause of superficial fungal infection of the skin. The emergence of epidemic-like attacks of those chronic and recurring represents a public health problem. Materials and Methods: Two hundred patients with suspected fungal infection of the skin attending the Dermatology and Venereology Department of Al-Ramadi Teaching Hospital were examined. Fifty-nine patients with chronic dermatophytosis were selected for the study and fifty of those were subjected for culture. History taking and a physical examination were conducted for all patients. A wet mount of 10% potassium hydroxide and culture on Sabouraud dextrose agar was done for selected cases. Results: Among 59 patients with chronic infections, the main age group affected was 29 years old, with a nearly equal sex ratio. The mean duration of the illness was 1.2 years. Tinea corporis was the most common type. The Trichophyton genera were the most common (65%), and Trichophyton mentagrophyte was the most common species isolated (46%). Conclusion: Multiple factors have been associated with the appearance of epidemic-like attacks of chronic dermatophyte infections in Iraq in the last several years. Herein, we would like to shed light on these factors and the pathogens responsible.

A clinicomycological study on chronic dermatophytosis in a tertiary care hospital in North India: An observational study

Background: Chronic dermatophytosis is a considerable challenge in routine clinical practice. There is, however, scarce information available in the literature on its extent and characteristics. Aim: The aim of this study was to evaluate the host-related factors of chronic dermatophytosis and to identify the common fungal isolates. Methods: The study enrolled a total of 145 cases of chronic dermatophytosis attending the out-patient department of a tertiary care hospital in Jammu from November 2017 through October 2018. A detailed history was taken, followed by a clinical examination and investigations such as routine baseline investigations, an absolute eosinophil count, a wet mount for direct microscopy, and a fungal culture. Results: The most common presentation was tinea corporis with tinea cruris (33.1%), followed by tinea corporis alone. The majority of the patients (54.5%) had more than 20% of the body surface area involved. Most of the patients were manual workers (n = 44; 30.3%). The number of hours of sun exposure varied between 1 to 8.5 hours (mean ± SD: 3.53 ± 1.75 h). The fungal culture was positive in 65 (44.8%) patients. The most frequent isolates were Trichophyton mentagrophytes (53.8%), followed by Trichophyton rubrum (38.5%). Conclusion: We found Trichophyton mentagrophytes the predominant pathogen in chronic dermatophytosis, followed by Trichophyton rubrum, which demonstrates a changing trend as far as the causative organism is considered. Besides, various risk factors for chronicity such as prolonged sun exposure, lack of proper hygiene, wearing tight-fitting synthetic clothes, the use of topical steroids, and non-compliance to treatment were identified.

Study of clinical profile of dermatophytosis in a tertiary care center as per ECTODERM guidelines

Background: Dermatophytic infections are one of the most common skin infections encountered by dermatologists. A recent increase in incidence has been seen over the last few years with substantial change in the clinical profile of patients. Recently a group of dermatology experts published Expert Consensus on The Management of Dermatophytosis in India (ECTODERM India). The group agreed upon various definitions with respect to current dermatophytosis epidemic as well as gave recommendations for investigations and management. Clinical profile of dermatophytosis was done in present study on the basis of definitions agreed upon by ECTODERM consensus group. Aims and Objective: To assess the clinical profile, prevalence and severity of dermatophytic infection in study population. Materials and Methods: Cross-sectional observational study was conducted at out-patient department of Dermatology in, Sharda hospital, Greater Noida. A total of 317 patients presenting with clinical diagnosis of dermatophytosis were included in the study. Results: A total of 317 patients were recruited in the study, out of which 213 were males (67.2%). The most common age group presenting with superficial dermatophytosis was 21-30 years. Majority of the patient presented with chronic dermatophytosis with duration more than 6 months (76.6%) while more than 3 lesions of tinea were observed in 76.6% cases. 191 patients (60%) had moderate to severe involvement with more than 3% of BSA involved. Family members presenting with similar complaints were seen in 39% cases. Majority of patients (76 %) studies had received previous treatment topical, systemic or both. 62 patients presented with recurrence of disease within 6 weeks of complete antifungal treatment (19.6%). Conclusion: Our study concludes that dermatophytosis still remain a challenging issue for dermatologists. Chronicity of infection, moderate to severe BSA involvement and involvement of family members in a good proportion of our study cases were the main findings of our study.

Clinical assessment of Super bioavailable Itraconazole 50 mg in dermatophytosis (Clear 50)

Super bioavailable itraconazole (SBITZ) is a newer formulation of itraconazole which is recently launched in India. But there is no published clinical evidence of SBITZ in the management of dermatophytosis in Indian patients. A Real world retrospective data analysis was conducted with 346 dermatologists across India to assess the response of Indian patients with dermatophytosis who were prescribed super bioavailable itraconazole 50 mg twice a day for 4 weeks.Out of 4625 patients’ data, 2743 were included for final analysis. Mean age of patients was 36.17±12.05 years with male preponderance. Most of the patients were diagnosed as T. cruris. At the end of treatment, 51% of patients achieved complete clinical cure while 46% achieved clinical improvement (>50% symptom clearance) and 3% were labelled as clinical failure. About 70% patients achieved clearance in body surface area. Mean total symptom score (TSS) was reduced to 0.74±1.1 from 7.29±1.73 while mean BSA score was reduced from 1.96±0.83 to 0.38±0.65 (p<0.05). Similar type of improvements were seen in naïve, recurrent and chronic dermatophytosis patients. A total of 61 adverse effects (AE) were reported from 56 patients. All the AEs were mild to moderate in nature and did not require discontinuation of therapy.Patients treated with super bioavailable itraconazole showed greater improvement in clearance of symptoms as well as lesions. Additionally, it showed significant improvement in naïve, recurrent and chronic patients enabling its placement in armamentarium of management of all types of dermatophytosis.

Recurrent and chronic dermatophytosis: culprit- not just antifungal resistance

<p><strong>Background</strong>: Recurrent and chronic dermatophytosis is being increasingly seen nowadays. Without drug susceptibility tests, it is difficult to say whether these are due to antifungal resistance or due to other factors.</p><p><strong>Methods:</strong> Hundred dermatophytosis patients, lasting for more than 6 months were enrolled. Detailed history was taken. A clinical examination and KOH preparation was done.</p><p><strong>Results:</strong> Out of total 100 patients, male to female ratio was 61:39. The most common age group was 16-30 years and 31-45years respectively. Tinea cruris with corporis was the common clinical type (44%) followed by tinea cruris alone (31%) and tinea corporis alone (25%). KOH was positive in 64%. History of delay in consulting doctor was present in 77%, home remedies in 19%, OTC drug usage in 46% among which 69.56% were steroid combined antifungals, treatment by non dermatologists in 52%. Adherence to therapy was seen only in 28%. The common aggravating factors were hot environment (60%), friction, occlusion and during menstruation. Family history of tinea was positive in 66%. No of baths were less than one per day in 8%, sharing of soap and clothing was seen in 41%.</p><p><strong>Conclusions: </strong>Misuse of OTC topical corticosteroids, multiple familial contacts, unhygienic practices, treatment by nondermatologists with inappropriate drug, dose and duration, poor compliance to treatment have all contributed to the emergence of chronic and recurrent dermatophytosis.</p>

Health Seeking Behavior and Cost of Care of Chronic Dermatophytosis: A Hospital-Based Cross-Sectional Study

Recent trend in onslaught of chronic and recurrent dermatophytosis not amenable to conventional dose and duration of antifungal agents has been observed in Nepal and India. The major factor implicated behind this surge is use of over-the-counter fixed drug combination containing topical steroids. This study aimed to examine the health seeking behavior, pattern of drug use and cost of care of chronic dermatophytosis in Nepalese population. Ninety-one patients with the diagnosis of chronic dermatophytosis of skin willing to participate in the study were recruited in a hospital-based, cross-sectional study. Information regarding demographic profile, health seeking behavior and cost incurred in the treatment of their dermatophytosis were recorded in a preset proforma. Mean age of study population was 30.49±13.50 years with M:F ratio of 2.25:1. Mean duration of illness was 20.68±6.44 months, with groin as the initial site of involvement in nearly half of cases. Commonest diagnoses were extensive dermatophytosis, followed by tinea cruris et corporis and tinea cruris. Nearly three-forth of patients reported seeking advice from local pharmacy and two-third reported using steroid containing topical agents for their skin problem. On an average, patients spent NPR 6,488.70 in a six months period and 3.03% of their income in the treatment of chronic dermatophytosis. This study highlighted the tendency of patients to seek advice from pharmacy dispensers, use of topical steroid containing agents in chronic dermatophytosis and substantial financial burden borne by patients in the treatment of the condition.

Quality Of Life In Patients With Chronic Dermatophytosis

Introduction: The term “chronic dermatophytosis” can be described as patients who have suffered tinea infections for more than 6 months, with or without recurrence. Since last few years we are facing an onslaught of chronic and recurrent dermatophytosis. These infections are increasingly becoming debilitating with severe symptoms like itching and increasingly showing lack of response to traditional treatment, hence it has become utmost important to assess impact of dermatophytosis today on quality of life of patients. Objectives: To determine quality of life in patients with chronic dermatophytosis using Dermatology Life Quality Index (DLQI). Materials and Methods: Adult literate patients having chronic dermatophytosis which was confirmed by KOH mount were included in the study. History, clinical features and other relevant details were included in a proforma. All patients were asked to fill DLQI questionnaire in Hindi. Controls having disease for less than six months were also included. Data thus obtained was collected and tabulated. The data was analysed using SPSS software and relevant statistical tests were used. Results: Total number of cases collected were 263, 137 controls were also included. In gender distribution, cases had 71.86% males and 28.14% female while controls had 63.5% males and 36.5% females. Mean DLQI of cases was 14.28+/-5.16 and controls was 11.56+/-3.60. DLQI distribution of cases -162(61.6%) had very large effect, 64(24.33%) had moderate effect, and 32(12.17%) had extremely large effect on DLQI. Domains of Symptoms and feelings (72.67%), work and school related activities (69%) and treatment related problems (67.67%) posed maximum impairment. Quality of life derangement increased significantly with presence of lesions on both exposed and non exposed sites and increase in body surface area. Conclusion: While superficial dermatophytosis affects quality of life (QoL) in all patients, chronic dermatophytosis has a significantly more derogatory effect on the QoL of a person with some of the patient also showing extremely large effect on QoL.