Varying Trends in Geographical Distribution and Patterns of Dermatophytosis and its Antifungal Susceptibility

Abstract

Background: Dermatophytosis is seen worldwide, causing severe physical, mental, and psychosocial morbidity to the patient. Owing to indiscriminate, inadequate and irregular use of various drugs, cases of anti-fungal resistance have emerged in recent times, leading to ineffective treatment needing multiple drugs over longer treatment durations. Hence, this study was taken up to evaluate the changing geographical trends in the clinico-mycological profile of dermatophytosis and its antifungal susceptibility patterns. Materials and Methods: Two hundred and eleven patients with clinically diagnosed dermatophytosis were evaluated with history, examination followed by a Potassium Hydroxide wet mount. Skin scrapings were also taken for fungal culture and antifungal susceptibility tests against ten commonly used antifungal agents using the Broth Microdilution method as per CLSI M38-A2 guidelines. Results: Tinea incognito was the most common presentation, and Trichophyton rubrum was the predominant dermatophyte isolated. Recurrent dermatophytosis was seen in 11.84% subjects. Terbinafine was the most effective systemic agent, while Luliconazole was the most effective topical agent. Itraconazole and Luliconazole were the most effective systemic and topical agents, respectively, at their lowest minimum inhibitory concentrations inhibiting T. rubrum isolates in vivo. Fluconazole, followed by Griseofulvin, showed the least efficacy. In vitro microbiological resistance to Griseofulvin was found in 15.3% of cases (P < 0.00001). Conclusion: The rapidly evolving geographical trends in clinico-epidemiological profiles of dermatophytosis and its varying antifungal susceptibility patterns highlight the need for updating the knowledge of this disease in the global scenario as well as counseling the rural populations with behavioral and lifestyle modifications.