Abstract
BackgroundDermatophytosis management has become an important public health issue, with a large void in research in the area of disease pathophysiology and management. Current treatment recommendations appear to lose their relevance in the current clinical scenario. The objective of the current consensus was to provide an experience-driven approach regarding the diagnosis and management of tinea corporis, cruris and pedis.MethodsEleven experts in the field of clinical dermatology and mycology participated in the modified Delphi process consisting of two workshops and five rounds of questionnaires, elaborating definitions, diagnosis and management. Panel members were asked to mark “agree” or “disagree” beside each statement, and provide comments. More than 75% of concordance in response was set to reach the consensus.ResultKOH mount microscopy was recommended as a point of care testing. Fungal culture was recommended in chronic, recurrent, relapse, recalcitrant and multisite tinea cases. Topical monotherapy was recommended for naïve tinea cruris and corporis (localised) cases, while a combination of systemic and topical antifungals was recommended for naïve and recalcitrant tinea pedis, extensive lesions of corporis and recalcitrant cases of cruris and corporis. Because of the anti-inflammatory, antibacterial and broad spectrum activity, topical azoles should be preferred. Terbinafine and itraconazole should be the preferred systemic drugs. Minimum duration of treatment should be 2–4 weeks in naïve cases and > 4 weeks in recalcitrant cases. Topical corticosteroid use in the clinical practice of tinea management was strongly discouraged.ConclusionThis consensus guideline will help to standardise care, provide guidance on the management, and assist in clinical decision-making for healthcare professionals.
Highlights
Dermatophytosis management has become an important public health issue, with a large void in research in the area of disease pathophysiology and management
An invitation to participate in the survey was sent by mail in April 2017, to 14 experts working in the field of clinical dermatology and mycology, selected by lead expert Dr Murlidhar Rajagopalan, according to their clinical experience, their interest in the field as reflected by their international publications, and further, on their experience in generating guidelines
Eleven experts including eight dermatologists, and three mycologists participated in five rounds of a web-based modified Delphi Method from April to September 2017, to develop both a consensual statement on the management of dermatophytosis in the current alarming situation of increased incidence, as well as the prevalence of dermatophytosis in India (Fig. 1)
Summary
Dermatophytosis management has become an important public health issue, with a large void in research in the area of disease pathophysiology and management. Dermatophytes, the most common causative agents, are assuming high significance in developing countries like India [1].These organisms metabolise keratin and cause a range of pathologic clinical presentations, including tinea pedis, tinea corporis, tinea cruris, etc. Dermatologists across India are inundated with cases of dermatophytosis presenting with unusual large lesions, ring within ring lesions, multiple site lesions (tinea cruris et corporis), and corticosteroid modified lesions, making diagnosis a difficult bet [5]. This changed face of dermatophytosis has created a real panic among dermatologists. The recent prevalence of dermatophytosis in India ranges from 36.6–78.4% [6] (Table 1)
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