Recurrent Dermatophytosis Research Articles

Prolonged treatment of dermatophytosis caused by Trichophyton indotinea with terbinafine or itraconazole impacts better outcomes irrespective of mutation in the squalene epoxidase gene.

Over the past decades, the increasing incidence of recurrent dermatophytosis associated with terbinafine-resistant Trichophyton has posed a serious challenge in management of dermatophytosis. Independent reports of failure of treatment and high minimum inhibitory concentrations (MIC) of antifungals are available, but data correlating MIC and clinical outcomes is still sparse. Therefore, the present study was conducted to evaluate the outcomes of systemic treatment of dermatophytosis and its correlation with MIC of the etiological agents isolated from such patients. Retrospective analysis of 587 consecutive patients with dermatophytosis was done from March 2017 to March 2019. Demographic and clinical details of the patients were noted, along with the results of direct microscopy and fungal culture. The isolates were identified by sequencing the internal transcribed spacer region of rDNA. Antifungal susceptibility testing was performed following the CLSI M38 protocol. Mutation in the squalene epoxidase (SE) gene was detected by DNA sequencing and ARMS-PCR. Based on the culture-positivity and prescribed systemic antifungal, patients were categorised into Group I culture-positive cases treated with systemic terbinafine and Group II culture-positive cases treated with systemic itraconazole, each for a total period of 12 weeks. In the present study, 477 (81.39%) were culture-positive; however, 12 weeks follow-up was available for 294 patients (Group I-157 and Group II-137) who were included for statistical analysis. In both groups [Group I-37/63 (51.4%) and Group II-14/54 (58.3%)], a better cure rate was observed if the initiation of therapy was performed within <6 months of illness. Treatment outcome revealed that if therapy was extended for 8-12 weeks, the odds of cure rate are significantly better (p < .001) with either itraconazole (Odd Ratio-15.5) or terbinafine (Odd Ratio-4.34). Higher MICs for terbinafine were noted in 41 cases (cured-18 and uncured-23) in Group I and 39 cases (cured-16 and uncured-23) in Group II. From cured (Group I-17/18; 94.4% and Group II-14/16; 87.5%) and uncured (Group I-20/23; 86.9% and Group II-21/23; 91.3%) cases had F397L mutation in the SE gene. No significant difference in cure rate was observed in patients with Trichophyton spp. having terbinafine MIC ≥ 1or <1 μg/mL (Group I-p = .712 and Group II-p = .69). This study revealed that prolonging terbinafine or itraconazole therapy for beyond 8 weeks rather than the standard 4 weeks significantly increases the cure rate. Moreover, no correlation has been observed between antifungal susceptibility and clinical outcomes. The MIC remains the primary parameter for defining antifungal activity and predicting the potency of antifungal agents against specific fungi. However, predicting therapeutic success based solely on the MIC of a fungal strain is not always reliable, as studies have shown a poor correlation between invitro data and invivo outcomes. To address this issue, further correlation of antifungal susceptibility testing (AFST) data with clinical outcomes and therapeutic drug monitoring is needed. It also highlights that initiation of the treatment within <6 months of illness increases cure rates and reduces recurrence. Extensive research is warranted to establish a better treatment regime for dermatophytosis.

Immunohistochemical analysis of chronic and recurrent dermatophytosis.

Dermatophytosis has assumed epidemic proportions with rising resistance, recalcitrance and recurrence, especially in tropical regions. While various factors contribute to high prevalence worldwide, yet little is known about the interactions between host defence mechanisms and dermatophytes, particularly in chronic and recalcitrant dermatophytosis. We aimed to compare the population of various immune cells in specimens of chronic recurrent dermatophytosis and those with acute superficial dermatophytosis. We investigated the density of various immune cells-Langerhans cells (CD1a+), macrophages (CD68+), dermal dendrocytes (Factor XIIIa+) in the skin of chronic dermatophytosis patients and those with successfully resolved lesions (controls). Langerhans cells were significantly decreased in the epidermis of patients, both in affected and unaffected areas in comparison with controls. In the dermis, however, no differences in the density of immune cells (macrophages and fibroblasts) were observed. The limited sample size and immune cells evaluated could be expanded further in future research. These results indicate that the decreased number of Langerhans cells could be a potential risk factor for the development of chronic and recurrent dermatophytosis.

Study of molecular characterization for diagnosis of chronic and recurrent dermatophytosis

Dermatophytes are the keratinophilic fungi which infect humans and is the most recurring type of disease. The high level of transmissibility creates an epidemiological risk and emphasises the significance of these illnesses. However, a growing number of reports describing dermatophytes can cause deep infections in diabetic and immunocompromised patients, by invading deep layers like the dermis and hypodermis. Despite the prevalence and significance of dermatophytes in clinical mycology, it is not always possible to accurately diagnose this specific infection due to its overlapping structures among species of dermatophytes. Since it is difficult to identify species that exhibit weak characteristics in the morphological highlights, identification of the dermatophyte is often relied on its morphological analysis, which is a laborious process and demands skill. The massive shift in genetic variation, the source of infection, and epidemiological research can be discovered using molecular approaches. Therefore, the development of an accurate laboratory test for dermatophyte species identification is essential for the prevention and efficient management of dermatophytoses. One such methodology allows use of PCR technology which has many methods for molecular level characterization which is rapid, efficient, and capable of producing DNA polymorphisms specific to various dermatophyte species based on distinctive band patterns seen by agarose gel electrophoresis. The RAPD-PCR approach will be used in this study protocol to molecularly characterize the dermatophytes for precise speciation of the sample. In addition to improving knowledge of fungal biology and pathology with a focus on adaptive mechanisms to combat difficult conditions from host counteractions, there is a need to improve awareness of the importance of these diseases through accurate epidemiological data. The advantages of molecular approaches for characterizing objects over traditional methods are their sensitivity and specificity.

Clinical and Mycological Characterization of Chronic and Recurrent Dermatophytes using Various Staining and Microscopic Methods

Dermatophytosis is a prevalent infection in tropical and subtropical countries, including India. This study aims to investigate the epidemiology and clinical aspects of chronic and recurrent dermatophytosis, identify the clinical isolates, and assess the effectiveness of different microscopy and staining methods for diagnosis. The objective of the study is to study the epidemiology and clinical aspects of chronic and recurrent dermatophytosis and to identify the clinical isolates. Attempts to improve the diagnostic outcome by implementing different microscopy and staining methods have also been performed. Adult patients with chronic and recurrent cases and positive direct microscopy were included, and clinical details were recorded. The mycological culture was performed. Fifteen isolates were selected randomly and subjected to 0.9% NaCl, Chicago sky blue staining, Calcofluor white staining, and Congo red staining in addition to the standard lactophenol cotton blue (LPCB) preparation. Among the 178 patients in the study, females (56.7%) and patients aged 25-45 (50%) were more frequently affected. Tinea corporis was the most common clinical type (89.32%). Recurrent cases (56.1%) were more prevalent than chronic cases (43.9%). Culture positivity was seen in 60.1%, with Trichophyton mentagrophytes being the most common isolate (86%). Among the staining methods used on 15 selected isolates, Lactophenol Cotton Blue (LPCB) was scored as the most effective, scoring 2.6 out of 3. The study revealed several clinical and epidemiological findings related to dermatophytosis in India, including a high degree of communicability, inadvertent therapies including topical steroid misuse, and a persistent nature requiring an extended duration of therapy. Trichophyton mentagrophytes was the most frequently isolated pathogen. Of the staining methods evaluated, Lactophenol Cotton Blue (LPCB) was found to be the most effective. The findings suggest a need for continued research into effective treatments and diagnostic methods for dermatophytosis in India.

Clinico-Mycological Profile of Recurrent Dermatophytosis with Drug Sensitivity in a Tertiary Care Center in Southern Odisha

Background: Recurrent dermatophytosis is a pressing problem worldwide due to inadequate treatment, drug resistance, and indiscriminate use of topical steroids. This scenario increases the need for the study of risk factors and antifungal susceptibility testing. There is a paucity of information on this subject. Objective: We aimed to find the clinico-mycological pattern of recurrent dermatophytic infections, the factors responsible for recurrence and determine the sensitivity pattern of isolates against four antifungals (fluconazole, itraconazole, terbinafine, and amphotericin B). Materials and Methods: Patients with recurrent dermatophytosis attending the outpatient Department of Our Tertiary Care Institute were enrolled in this study. A detailed history was taken; clinical examination was done; samples were collected for mycological examinations, and in-vitro antifungal sensitivity testing was done by broth microdilution method as per Clinical and Laboratory Standard Institute M38-A guidelines. Results: One hundred and twenty-eight patients were included in the study with a male:female ratio of 1.38:1. The most commonly affected age group was 31–40 years. Tinea corporis with tinea cruris was the most common type of clinical presentation. Potassium hydroxide mount was positive in 53 samples and culture was positive in 59 samples. Trichophyton rubrum was the predominant species isolated, followed by Trichophyton mentagrophytes. On in-vitro antifungal susceptibility testing, itraconazole and amphotericin B had the lowest minimum inhibitory concentrations (MIC), followed by terbinafine. Fluconazole had the highest MIC among the drugs tested. Conclusion: Topical corticosteroid abuse, lack of personal hygiene, and habit of sharing clothes were seen in many patients with recalcitrant dermatophytosis. T. rubrum was the most common isolated species. Antifungal susceptibility testing revealed itraconazole and amphotericin B to have the lowest MIC value and fluconazole to have the highest MIC value.

A Clinico-Mycological and Histopathological Study of Recurrent Dermatophytosis

Background: A few recent studies have shown fungal elements within the hair follicle epithelium, which may act as a reservoir and responsible for recurrent dermatophytosis. Objectives: To assess the clinical patterns, mycological profile, and histopathology of recurrent dermatophytosis and to determine the prevalence of fungal hyphae in the hair follicle epithelium and other appendages. Materials and Methods: One hundred and fifty clinically diagnosed cases of recurrent dermatophytic infection were included. Skin samples were taken for direct microscopy, fungal culture, and histopathological analysis. Haematoxylin and eosin and special staining with periodic acid Schiff (PAS) and Gomori's methenamine silver (GMS) were performed to detect the fungal hyphae in the skin and hair follicle epithelium. Results: The most common clinical pattern observed was tinea corporis et cruris in 64 patients (42.66%). On direct microscopy and fungal culture, positive results were obtained in 116 cases (77.33%) and 78 (52%) cases, respectively. Presence of fungal hyphae in the stratum corneum, hair follicle, and acrosyringium was seen in 107 patients (71.33%), 47 patients (31.33%), and five patients (3.33%), respectively. Out of the 52 cases with hair follicle and eccrine gland involvement, history of fixed drug combinations (FDC) cream use was present in 42 cases (80.76%) and absent in ten cases (19.24%) (P = 0.000062). Limitations: Skin samples were taken only from a single skin lesion. Higher incidence of follicular invasion may have been detected if multiple biopsy samples were taken. Conclusion: Hair follicle/eccrine sweat gland involvement was observed in nearly one-third of the patients, which may act as a reservoir and may be responsible for recurrence and chronicity. Histopathology should be considered as an important adjuvant tool in recurrent dermatophytosis to establish the extent of the infection, which guides the further management.

Recurrent Dermatophytosis: A Comparative Therapeutic Study using Oral Itraconazole Alone and in combination with Topical Tincture of Iodine

Widespread resistant dermatophytosis cases have been increasing in frequency in Iraq, despite prolonged treatment protocol. This study aimed to compare the therapeutic effect of oral itraconazole alone and in combination with topical tincture of iodine as an adjuvant therapy for refractory dermatophytosis. A comparative research was conducted in the Dermatology and Venereology Department, Ramadi Teaching Hospital. A total number of 130 cases with recurrent tenia were enrolled in this study. All patients were diagnosed on clinical basis and direct microscopic examination. They divided into two groups depending on the line of treatment. Only 120 patients completed the study, 82(68.3%) were males, and 38(31.7%) were female. The age ranged (18-60 years) with mean (± SD) 33.3+12.7. Marked improvement and clinical cure at 2 weeks were highly significant level in 44(75.9%) cases of those treated by 5% topical tincture of iodine plus oral itraconazole, VS 14(24.1%) of individual treated by only oral itraconazole. While there was no significant difference in cure rate between both groups at 12 weeks follow up. Topical 5% iodine tincture is recommended as a synergistic antifungal activity in combination with oral itraconazole in treatment of recurrent tinea infections.

Acitretin: Could it be a new therapeutic player in the field of onychomycosis?

Onychomycosis represents a therapeutic challenge. The complete cure rate with itraconazole pulse therapy remains unsatisfactory implying the need for an effective therapeutic regimen. Given the successful treatment of recurrent dermatophytosis with isotretinoin and itraconazole, we investigated the therapeutic use of acitretin in onychomycosis. To evaluate and compare the efficacy of combined itraconazole and acitretin versus monotherapy with each in onychomycosis. The study included 135 adult patients with finger- and/or toenail onychomycosis. They were equally subdivided into 3 groups: itraconazole pulse therapy, acitretin and combined itraconazole/acitretin therapy. The drugs were administered for 3months. Evaluation of severity was done by onychomycosis severity index score. Potassium hydroxide microscopy and culture were performed at baseline and at the end of the study. Mycological and complete cure of onychomycosis was observed in 51.1% and 20% of the itraconazole group, 28.9% and 28.9% of the acitretin group, and 80% and 53.3% of the combined group. There was a statistically significant difference between groups in favour of the combined itraconazole/acitretin therapy (P≤.05). Small sample and short therapy duration. Acitretin could be a powerful therapeutic player in the field of onychomycosis, with greater efficacy when combined with itraconazole.

Utility of molecular characterization in the diagnosis of chronic and recurrent dermatophytosis.

Utility of molecular characterization in the diagnosis of chronic and recurrent dermatophytosis.

Efficacy and Safety of Adding Low-Dose Isotretinoin to Itraconazole in the Treatment of Chronic Recurrent Dermatophytosis among Sample of Iraqi Patients: An Open-Labelled Therapeutic Clinical Comparative Study.

An increasing number of dermatophytosis is seen now in daily clinical practice, with unusual presentations, running a chronic recurrent course and seems to be more resistant to systemic and topical conventional treatments, which necessitate the use of other treatment options that help to cure these challenging clinical conditions such as isotretinoin along with itraconazole. This is a prospective randomised open-label therapeutic comparative clinical trial to assess the efficacy and safety of low-dose isotretinoin along with itraconazole to treat and reduce the recurrence of this distressing chronic recurrent dermatophytosis. Eighty-one patients with chronic recurrent dermatophytosis with positive mycological examination were recruited, all of them received itraconazole for 7 days per month for 2 consecutive months duration; half of them were randomly chosen to receive low-dose isotretinoin every other day for 2 months in addition to itraconazole. All patients were followed up at monthly intervals for 6 months. The patients who received isotretinoin along with itraconazole showed earlier and complete clearance in 97.5% with a significantly low recurrence rate (12.8%) in comparison with those who received itraconazole alone where the cure rate was relatively slower reported in 53.7% of the patients with a relapse rate of 68.1% with no significant side effects. Low-dose isotretinoin with itraconazole seems to be safe, effective and promising choice in the treatment of chronic recurrent dermatophytosis as it induced earlier complete cure with a significant reduction of recurrence rate.

Impact of chronic and recurrent dermatophytosis on quality of life and psychologic morbidity-a cross-sectional study.

Chronic and recurrent dermatophytosis is adversely effecting the psychosocial well-being of patients. To assess the impact of chronic and recurrent dermatophytosis on quality of life and psychological well-being of patients. We performed a cross-sectional study on patients of chronic and recurrent dermatophytosis aged >12years. Clinical diagnosis was done, followed by appropriate investigations when required. The patients were made to fill up the questionnaires on Dermatology Life Quality Index, Hospital Anxiety and Depression Scale, and Perceived Stress Scale in English and local languages. The responses were coded with 4-point Likert scale. Statistical analysis was done using MedCal® V.125.0. Data of 123 patients were analyzed. Mean DLQI score was 21.4±5.6 and main domain affected was "symptoms and feelings." CRD had an "extremely large effect" on QoL (DLQI score 21-30) in 55.3% patients. Mean HADS-A(anxiety) score was 10.1±3.6, and mean HADS-D(depression) score of participants was 7.8±3.2. Mean perceived stress scale (PSS) score was 18.8±4.3. Involvement of >1site was a risk factor for higher DLQI score suggestive of "extremely large impact" on QoL (OR 34.02,95% CI 5.7-203.2,p=0.0001), higher/worsened HADS-A score (OR 5.4, 95% CI 1.2-22.9, p=0.02), and higher/worsened PSS score (OR 6.1, 95% CI 1.1-34.1, p=0.04). Persistent disease >1year (OR 11.5, 95% CI 1.9-67.8, p=0.007) and male gender (OR 0.3, 95% CI 0.1-0.8, p=0.01) were significant risk factors for anxiety while BSA involvement >10% was a significant risk factor for moderate to severe perceived stress(OR 13.9, 95% CI 1.5-130.7, p=0.02). Chronic and recurrent dermatophytosis requires a multidisciplinary approach involving psychiatrists, to reduce the psychological burden.

A multicentric clinical and epidemiological study of chronic and recurrent dermatophytosis in India.

There has been an alarming increase in the prevalence of chronic, recurrent and steroid modified dermatophytosis of the glabrous skin in the recent years in India. There is paucity of literature on the magnitude of this major public health problem. To estimate the prevalence of dermatophytosis and clinico-epidemiological features of chronic and recurrent dermatophytosis (CRD) across India and to evaluate the associated risk factors. This is a multicentric descriptive cross-sectional study conducted in 13 centres situated across India in two phases during dry and rainy seasons. All consecutive patients presenting with dermatophytosis were screened during the study period of 14 consecutive working days. Patients with CRD of the glabrous skin as per the case definition were included after exclusion of isolated hair and nail infections. Demography, clinical findings and results of potassium hydroxide wet mount were recorded. A total of 41,421 patients were screened, out of which 7174 (17.31%) patients had glabrous dermatophytosis. CRD was observed in 1999 (27.86%) patients with 78.08% and 21.95% of chronic and recurrent dermatophytosis, respectively. Family history was present in 50.03% of patients. History of sharing of fomites was present in 50.37% of them. Synthetic tight clothes were worn by 43.47%, while 50.9% gave history of misuse of topical corticosteroid creams. Multiple site involvement was common (69.58%) with tinea cruris (79.99%) and tinea corporis (75.69%) being the most common clinical types. CRD is associated with sharing of fomites, topical corticosteroid misuse and involvement of multiple sites.

Evaluation of efficacy and safety of oral voriconazole in the management of recalcitrant and recurrent dermatophytosis.

Dermatophytosis is a worldwide public health problem, affecting > 25% of the world's population. There has been a rampant increase in the resistant, recurrent dermatophytosis in the past few years, especially in India. Azole resistance in dermatophytes has been reported to be as high as 19% worldwide, hence evaluating the efficacy and safety of a newer oral antifungal is important. To evaluate the efficacy and safety of oral voriconazole in the management of recalcitrant and recurrent dermatophytosis. Patients with extensive, recurring and resistant dermatophytosis. The clinical diagnosis was confirmed by potassium hydroxide staining. Patients were given a 2-week course of oral voriconazole, administered as 800 mg on Day 1, followed by two daily doses of 200 mg (total 400 mg/day) for the remaining 13 days. The patients were followed up in Week 2 to assess response and in Week 6 to assess recurrence. Patients were monitored for any adverse effects (AEs). In total, 40 patients completed the study. Complete clearance was seen in 90% and 75% at Weeks 2 and 6, respectively. By the end of Week 6, eight patients (20%) had partial improvement of disease without complete clearance and only 5% had recurrence. No AEs were recorded during the treatment course. Voriconazole, a novel oral antifungal that can be used for treatment of recurrent and resistant dermatophytosis, has a good efficacy and safety profile with a very low rate of recurrence.

Immunological response and clinical profile in patients with recurrent dermatophytosis.

An alarming increase in the number of patients with chronic and recurrent dermatophytosis has invoked the need to study the immunological parameters of the host. To evaluate delayed type of hypersensitivity (DTH) response and immediate hypersensitivity (IH) response by flow cytometry evaluation of immune cells from peripheral blood and intradermal trichophyton skin test in patients with recurrent dermatophytosis. A hundred patients with recurrent dermatophytosis and 50 controls (healthy controls and acute dermatophytosis controls) were included. Relevant risk factors for recurrence were analysed, and serum IgE levels were estimated. Flow cytometry evaluation of immune cells in peripheral blood and intradermal trichophyton skin test was done. Dermatophyte pathogens were isolated, and antifungal susceptibility was performed. Trichophyton mentagrophytes complex (95.84%) and T.rubrum (4.16%) were isolated in culture. Serum IgE was elevated in 83.15% cases (p=.01). IFN-γ+ cells (p=.0501, p=.0001, p=.0014), Th1 cells (p=.1197, p=.0024, p=.0169), IL-17+ cells (p=.0127, p=.0006, p=.0007) and Th17 cells (p=.0634, p=.0001, p=.0054) were reduced, and IL-4+ cells (p=.0108, p=.0175, p=.0018) were increased in cases. Intradermal test demonstrated negative DTH response in all cases (p<.001, p<.001, p<.001), strongly positive IH response in 6%, and borderline positive IH response in 85% cases (p=.018, p<.001, p<.001). Topical corticosteroids application, undergarment types (tight fit), poor frequency of washing clothes, family history of tinea, sharing of towels were significant risk factors for recurrent dermatophytosis. Reduced IFN-γ+ , Th1, IL-17+ and Th17 cells population along with impaired DTH response by the intradermal test was observed in patients with recurrent dermatophytosis.

A Comparative Study of Efficacy of Oral Terbinafine and Oralitraconazole in Tinea Corporis / Tinea Cruris Infection

Dermatophytoses which are superficial fungal infections of the skin, hair, and nail are among the most common infective dermatoses seen in dermatology outpatient clinics. Today, we are facing an onslaught of chronic and recurrent dermatophytosis in volumes never encountered previously. Itraconazole was found to be the better antifungal in terms of clinical cure,mycological clearance and less need for extension of treatment than Terbinafine. Overall, oral Itraconazole 200 mg/day for 2 weeks proved to be a better agent with excellent and significantly better cure rates than oral Terbinafine 500mg/day for 2 weeks. With Itraconazole, the contra-indications, drug interactions must be kept in mind to prevent loss of efficacy/ potentially hazardous interactions. Both drugs had a good safety profile and few minor adverse events. The reasons for extension of treatment comprise chronicity, previous treatment with OTC steroid preparations, and misuse of systemic antifungal drugs, diabetes, and obesity. Poor personal practices and hygiene also havetheir contribution. Significant associations were also noted between diabetes and chronicity.

Recurrent and chronic dermatophytosis: culprit- not just antifungal resistance

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: 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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Hundred dermatophytosis patients, lasting for more than 6 months were enrolled. Detailed history was taken. A clinical examination and KOH preparation was done.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; 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%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;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.&lt;/p&gt;

Oral Isotretinoin Combined with Oral Terbinafine Versus Oral Terbinafine Alone to Treat Recurrent Dermatophytosis: An Open-Label Randomised Clinical Trial.

Background:Recurrent dermatophytosis is becoming arduous to treat. Recently, oral itraconazole with oral isotretinoin was successful in a patient suffering from recurrent dermatophytosis.Objectives:To evaluate if oral isotretinoin confers any added benefit over oral terbinafine in the treatment of recurrent dermatophytosis.Materials and Methods:This was an open-label randomized clinical trial including 100 adult patients with recurrent tinea cruris and/or tinea corporis randomized into two groups; Group A (oral isotretinoin 0.5 mg/kg/day and oral terbinafine 250 mg twice daily) and Group B (oral terbinafine 250 mg twice daily) for 4 weeks, and followed up for 3 months. Fungal culture and antifungal susceptibility testing against terbinafine, fluconazole, amphotericin B, itraconazole, and griseofulvin were performed.Results:Out of the 100 patients, 91 patients (44 in Group A and 47 in Group B) completed the trial. Complete cure was seen in 19/44 (43.18%) patients in Group A and 20/47 (42.55%) patients in Group B (P = 0.951). Recurrence occurred in 12/19 (63.1%) patients in Group A and 13/20 (65%) patients in Group B (P = 0.904). Cheilitis and dryness of lips were the most common adverse effects seen in 32/44 (72.73%) patients in Group A. A total of 50 cultures were grown. The commonest species isolated was Trichophyton interdigitale in 36 (72%) patients, having a mean minimum inhibitory concentration of 3.13 μg/mL for terbinafine. However, for itraconazole, it was 0.13 μg/mL, and varied minimum inhibitory concentration (MIC) values were seen for fluconazole, griseofulvin, and amphotericin B.Conclusion:The addition of isotretinoin to terbinafine has no added benefit in treating patients with recurrent dermatophytosis.

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

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 &lt; 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.

Pediatric dermatophytosis of the skin: current clinico epidemiological and antifungal susceptibility patterns in a tertiary care rural hospital

Background: Dermatophytosis is a common infection seen in tropical countries like India. With the onset of the 21st century, cases of antifungal resistance in dermatophytoses began to emerge as a therapeutic challenge. While tinea capitis, the predominant presentation in pediatric age group, has been extensively studied, the current scientific literature lacks in articles that assess the antifungal susceptibility patterns in pediatric dermatophytosis particularly involving the skin. Objective: This study attempts to identify and assess the changing clinico-epidemiological trends in the profile of pediatric dermatophytosis involving the skin, and its antifungal susceptibility patterns. Materials and Methods: Thirty subjects of 0–18 years of age with clinically diagnosed dermatophytosis were evaluated with history, examination and followed by a potassium hydroxide wet mount. Skin scrapings were also taken for fungal culture and antifungal susceptibility test against 10 commonly used antifungal agents using Broth Microdilution method as per Clinical and Laboratory Standards Institute (CLSI) M38-A2 guidelines. Results: Trichophyton rubrum was the most common dermatophyte isolated. Recurrent dermatophytosis was seen in 20% subjects. Tinea corporis was the predominant presentation. Steroid-modified Tinea was observed in 33.33% cases. Based on in vitro antifungal susceptibility testing, terbinafine and luliconazole were found to be the most effective systemic and topical agents, respectively. Conclusion: The rampant use of over-the-counter medications containing topical steroids is a rising issue in the treatment of both adult and pediatric dermatophytosis. Education and counseling of patients are very important for correct treatment of the condition and also to prevent the rise of recurrent infections.

Clinical and mycological features of recurrent dermatophytosis: A hospital-based observational cross-sectional study

Clinical and mycological features of recurrent dermatophytosis: A hospital-based observational cross-sectional study