Abstract
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.
Highlights
Dermatophytosis is a common superficial fungal infection of keratinized tissue caused by dermatophytes which belong to the genera Trichophyton, Microsporum and Epidermophyton and encompasses infections of skin, hair and nails.[1]
The inclusion criteria were as follows: patients of any age and sex with the diagnosis of chronic dermatophytosis of skin, with persistent and progressive lesions or recurrent lesions[13] and those who have undergone any form of treatment, procedure or investigation for dermatophytosis for which the patient had to pay himself/herself
Chronic and recurrent dermatophytosis contributed to about 5-10% of all cases in the dermatology clinic in a tertiary referral center in North India.[6]
Summary
Dermatophytosis is a common superficial fungal infection of keratinized tissue caused by dermatophytes which belong to the genera Trichophyton, Microsporum and Epidermophyton and encompasses infections of skin, hair and nails.[1]. Chronic dermatophytosis is the term coined for dermatophytosis occurring for more than six months to one year, with or without recurrence, in spite of being adequately treated. Recurrent dermatophytosis is defined as recurrence of lesions within few weeks (less than six weeks) after completion of treatment.[5] In recent years, there has been an emergence of chronic and recurrent dermatophytosis in high volumes in our clinics as has been reported from studies in India.[6,7,8,9,10] The present situation in India has been implicated mostly to overuse of available, inexpensive fixed drug combination (FDC) topical agents (steroid, anti-fungal and anti-bacterial) which can be purchased overthe-counter without doctor’s prescription.[10] The situation is no different in Nepal.[11,12]
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