Defining ‘difficult dermatophytosis’ beyond chronic/ recurrent forms: A clinico-etiological analysis from a teaching hospital in Northern India
Difficult Dermatophyptosis
DOI:
https://doi.org/10.66344/jpad.v33i3.2232Keywords:
Dermatophytes, Trichiphyton, Epidemiology, DermatophytosisAbstract
Objective We aimed to study and define “difficult dermatophytosis” encountered frequently; as well as examine demography, patient practices and clinico-etiological pattern among these patients.
Methods A prospective, cross-sectional study was conducted to include 93(n) cases (after informed consent) from the patients attending the outpatient department in the Department of Dermatology, Venereology and Leprology between August 2019 and August 2020. The inclusion criteria were: - age >12 years and fulfilling one or more criteria defining “difficult dermatophytosis’ i.e. multiple/ large lesions, multifocal, recurrent therapy, multiple relapses, clustering and chronicity. The clinico-demographic data was recorded in a pre-designed pro forma, a KOH examination for skin scraping and fungal culture was done for all cases. Data was analysed with SPSS version 20.
Results Males outnumbered females (M: F =1.2:1) and majority (67.8%) of patients were <40 years (Mean=34.13±11.5; Median=31yrs.). Body Mass Index (BMI) was higher than 25 in 55.9% cases; mean BMI seen in the study was 25.17±4.60. Multiple/large lesion (90.3%) was most common inclusion criteria followed by multifocal lesions (84.9%). All patients had tinea cruris; tinea corporis was most commonly associated followed by tinea faciei lesions. A significant proportion (76.3%) of cases had ≥4 family members cohabiting with them (Mean=5.07±0.03); more than half (56.98%) had an affected family member (Mean=0.90±1.00). The most common co-morbid condition seen was atopy seen in 16 (17.2%) patients. Presentation for dermatology consult was delayed by >1 month in 81.7% cases; >6 months in 47.3% cases and >1 year in 26.9% cases. A strong statistical association was found of multiple relapses with ‘delay in dermatology consults’ (p value=0.002). A significant association of delay was also seen with chronicity (p value=0.046) was also seen. Nearly three-fourth study participants (72%) reported prior use of topical corticosteroid; oral (11.8%) and parental (20.4%) use were also reported. Prior use of luliconazole (40.8%) was most commonly reported among topical drugs, whereas itraconazole was used by 46% patients previously. Irrational use of anti-fungals was seen in 75%; including inappropriate doses (18%), inappropriate duration (34%), poly-pharmacy (6%) and non-compliance (1%). A statistically significant association of irrational use was found with multiple/large lesions (p value=0.008).
Conclusion We propose this definition for the unusual presentations of the disease, particularly in the Indian sub-continent. Better access to clinical dermatology services and rational use of systemic anti-fungals as a means to mitigate difficult dermatophytosis.
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