Chronic dermatophytosis: Clinico-mycological determinants and antifungal susceptibility pattern

Abstract

Background: Recent years have witnessed a dramatic increase in chronic unresponsive dermatophytosis. A study was conducted to quantify the proportion of patients with chronic dermatophytosis and to determine the clinico-mycological predictors of chronicity including antifungal susceptibility. Methods: Hospital-based cross-sectional study design was adopted. Four hundred and twenty-five patients were studied. The outcome variable was chronic dermatophytosis and the determinants were clinico-mycological characteristics. Chi-square and odds ratio (OR) with 95% confidence interval (CI) were calculated. Results: Chronic dermatophytosis was seen in 29.4%. Past history of dermatophytosis, OR 0.44 (95% CI 0.28–0.68); family history of dermatophytosis, OR 1.66 (95% CI 1.06–2.56); HIV infection, OR 9.88 (95% CI 1.09–89.33); treatment with topical antifungals, OR 2.4 (95% CI 1.5–3.9); systemic antifungals, OR 3.9 (95% CI 2.5–6.1); topical steroids, OR 2.02 (95% CI 1.25–3.25); multiple-site infection, OR 1.97 (95% CI 1.24–3.13); and tinea unguium, OR 6.52 (95% CI 2.89–14.7) were the significant determinants. Trichophyton mentagrophytes (73.6%) was the most common isolate followed by Trichophyton rubrum and Microsporum gypseum (13.2%) each. A percentage of 77.4 of the isolates were resistant—73.6% isolates to terbinafine and 3.8% isolates to fluconazole. None of the isolates were resistant to itraconazole. Conclusion: Significant determinants were host-related factors. Thorough history taking, patient examination, and education can improve the present scenario. Microbiological resistance was not a significant predictor. High proportion of resistant strains should be an eye opener. Developing and adopting a standard uniform treatment protocol throughout the country should be the need of the hour.

Keywords

• antifungal susceptibility
• chronic dermatophytosis
• risk factors