Antifungal susceptibility pattern of dermatomycosis in a tertiary care hospital of North India


  • Ravika K. Budhiraja Department of Dermatology, Venereology & Leprosy, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
  • Saurabh Sharma Department of Dermatology, Venereology & Leprosy, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
  • Sarbjeet Sharma Department of Microbiology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
  • Jasleen Kaur Department of Dermatology, Venereology & Leprosy, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
  • Roopam Bassi Department of Physiology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India



Dermatomycosis, Antifungal resistance, Microbroth dilution


Background: Dermatomycoses affect the outer layers of the skin, nails and hair without tissue invasion and are often caused by dermatophytic molds, candida & non dermatophytic molds. Although not dangerous, they are important as a public health problem particularly in the immunocompromised. There are limited studies on the efficacy of antifungal agents against dermatophytes in North India.

Methods: This study was conducted to test the efficacy of 5 systemic antifungal agents viz. voriconazole, itraconazole, terbinafine, fluconazole & griseofulvin using Microbroth dilution technique.

Results: Three different species of dermatophytes which were isolated from the clinically suspected cases were Trichophyton mentagrophytes, T. rubrum and M. gypseum. According to the obtained results, Itraconazole and Voriconazole showed the lowest MIC range while Fluconazole and Griseofulvin had the highest MIC range for most fungi tested.

Conclusions: Despite several treatment options being available for cutaneous fungal infections, due to an inappropriate response, there is an increasing need for determining an antifungal susceptibility profile for specific fungal strains. This will enable the clinician to select an appropriate antifungal agent with minimal side effects to avoid antifungal resistance and treatment failure.


Agarwal U, Saran J, Agarwal P. Clinico-mycological study of dermatophytes in a tertiary care centre in northwest India. Indian J Dermatol Venereol Leprol. 2014;80(2):194.

Ho KM, Cheng TS. Common superficial fungal infections-a short review. Med Bull. 2010;15(11):23-7.

Sharma V, Kumawat TK, Sharma A, Seth R, Chandra S. Distribution and prevalence of dermatophytes in semi-arid region of India. Adv Microbiol. 2015;5(02):93-106.

Gupta AK, Cooper EA. Update in antifungal therapy of dermatophytosis. Mycopathologia. 2008;166(5-6):353-67.

Yenişehirli G, Tunçoğlu E, Yenişehirli A, Bulut Y. In vitro activities of antifungal drugs against dermatophytes isolated in Tokat, Turkey. Int J Dermatol. 2013;52(12):1557-60.

Artis WM, Odle BM, Jones HE. Griseofulvin-resistant dermatophytosis correlates with in vitro resistance. Arch Dermatol. 1981;117(1):16-9.

Korting HC, Rosenkranz S. In vitro susceptibility of dermatophytes from Munich to griseofulvin, miconazole and ketoconazole. Mycoses. 1990;33(3):136-9.

Chadeganipour M, Nilipour S, Havaei A. In vitro evaluation of griseofulvin against clinical isolates of dermatophytes from Isfahan. Mycoses. 2004;47(11-12):503-7.

Achkar JM, Fries BC. Candida infections of the genitourinary tract. Clinical Microbiol Rev. 2010;23(2):253-73.

Wayne PA. Reference method for broth dilution antifungal susceptibility testing of filamentous fungi: approved standard. CLSI Document M38-A2. 2008;22(16):16-36.

Waldvogel FA. Infectious diseases in the 21st century: old challenges and new opportunities. Int J Infect Dis. 2004;8(1):5-12.

Sheikh S, Ahmad A, Ali SM, Paithankar M, Barkate H, Raval RC. Topical delivery of lipid based amphotericin B gel in the treatment of fungal infection: A clinical efficacy, safety and tolerability study in patients. J Clin Exp Dermatol Res. 2014;5(248):2

Bhatia VK, Sharma PC. Epidemiological studies on Dermatophytosis in human patients in Himachal Pradesh, India. Springerplus. 2014;3(1):134.

Sahai S, Mishra D. Change in spectrum of dermatophytes isolated from superficial mycoses cases: First report from Central India. Indian J Dermatol Venereol Leprol. 2011;77(3):335-6.

Surekha A, Ramesh Kumar G, Sridevi K, Murty DS, Usha G, Bharathi G. Superficial dermatomycoses: A prospective clinicomycological study. J Clin Sci Res. 2015;4:7-15.

Narasimhalu CR, Kalyani M, Somendar S. A cross-sectional, clinico-mycological research study of prevalence, aetiology, speciation and sensitivity of superficial fungal infection in Indian patients. J Clin Exp Dermatol Res. 2016;7(324):2.

Patel P, Mulla S, Patel D, Shrimali G. A study of superficial mycosis in south Gujarat region. Natl J Commun Med. 2010;1(2):85-8.

Santos DA, Hamdan JS. In vitro antifungal oral drug and drug-combination activity against onychomycosis causative dermatophytes. Sabouraudia. 2006;44(4):357-62.

Gupta AK, Kohli Y. In vitro susceptibility testing of ciclopirox, terbinafine, ketoconazole and itraconazole against dermatophytes and nondermatophytes, and in vitro evaluation of combination antifungal activity. Br J Dermatol. 2003;149(2):296-305.

Fernández-Torres B, Inza I, Guarro J. In vitro activities of the new antifungal drug eberconazole and three other topical agents against 200 strains of dermatophytes. J Clin Microbiol. 2003;41(11):5209-11.

da Silva Barros ME, de Assis Santos D, Hamdan JS. In vitro methods for antifungal susceptibility testing of Trichophyton spp. Mycological research. 2006;110(11):1355-60.

Mukherjee PK, Leidich SD, Isham N, Leitner I, Ryder NS, Ghannoum MA. Clinical Trichophyton rubrum strain exhibiting primary resistance to terbinafine. Antimicrobial Agents and Chemotherapy. 2003;47(1):82-6.

Ghannoum MA, Chaturvedi V, Espinel-Ingroff A, Pfaller MA, Rinaldi MG, Lee-Yang W, et al. Intra-and interlaboratory study of a method for testing the antifungal susceptibilities of dermatophytes. J Clin Microbiol. 2004;42(7):2977-9.

Galuppi R, Gambarara A, Bonoli C, Ostanello F, Tampieri MP. Antimycotic effectiveness against dermatophytes: comparison of two in-vitro tests. Vet Res Commun. 2010;34:S57–S61.

Favre B, Hofbauer B, Hildering KS, Ryder NS. Comparison of in vitro activities of 17 antifungal drugs against a panel of 20 dermatophytes by using a microdilution assay. J Clin Microbiol. 2003;41(10):4817-9.

Sarifakioglu E, Seçkin D, Demirbilek M, Can F. In vitro antifungal susceptibility patterns of dermatophyte strains causing tinea unguium. Clin Experimental Dermatol. 2007;32(6):675-9.

Korting HC, Ollert M, Abeck D. Results of German multicenter study of antimicrobial susceptibilities of Trichophyton rubrum and Trichophyton mentagrophytes strains causing tinea unguium. German Collaborative Dermatophyte Drug Susceptibility Study Group. Antimicrobial agents and chemotherapy. 1995;39(5):1206-8.

Deng S, Zhang C, Seyedmousavi S, Zhu S, Tan X, Wen Y, et al. Comparison of the in vitro activities of newer triazoles and established antifungal agents against Trichophyton rubrum. Antimicrobial Agents Chemotherapy. 2015;59(7):4312-4.

Esteban A, Abarca ML, Cabanes FJ. Comparison of disk diffusion method and broth microdilution method for antifungal susceptibility testing of dermatophytes. Medical mycology. 2005;43(1):61-6.

Fernández-Torres B, Carrillo AJ, Martın E, Del Palacio A, Moore MK, Valverde A et al. In vitro activities of 10 antifungal drugs against 508 dermatophyte strains. Antimicrobial Agents Chemotherapy. 2001;45(9):2524-8.

Ghannoum M, Isham N, Sheehan D. Voriconazole susceptibilities of dermatophyte isolates obtained from a worldwide tinea capitis clinical trial. J Clin Microbiol. 2006;44(7):2579-80.






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