Recurrent and chronic dermatophytosis: culprit- not just antifungal resistance

Abstract

Background: 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.

Methods: Hundred dermatophytosis patients, lasting for more than 6 months were enrolled. Detailed history was taken. A clinical examination and KOH preparation was done.

Results: 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%.

Conclusions: 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.