Familial Dermatophytosis in India: A Study of the Possible Contributing Risk Factors

Background: Dermatophytes are keratinophilic fungi responsible for skin, nail, and scalp infections. Chronic dermatophytosis, defined as persistent infection for six months or more, was very rare in the 1980s and mostly limited to patients with nail involvement, but this is no longer true. Currently, patients with chronic dermatophytosis are increasing, and about 50 percent of patients with dermatophytosis have at least one other member of their family infected at the same time, sometimes with entire families being affected at once. Objective: We sought to study the possible risk factors associated with familial dermatophytosis. Methods: The present questionnaire-based study was conducted from May 2017 to July 2017. Patients with a clinical diagnosis of dermatophytosis and at least one other family member affected were included. A proforma was filled and history was taken, including number of family members affected, site of infection in the index case, site(s) of infection of all other subsequent family members affected, and use of over-the-counter drugs. Results: Out of the 113 families surveyed, which included 673 subjects, a little over half (55.4%) were affected by dermatophytosis. In 103 families, the initial site of infection in the subsequent family member affected was the same site as that affected in the first member. All families reported a history of using an irritant soap and over-the-counter drugs. Washing all the family's clothing together was a common factor. All families had a single bathroom and used the same soap and stool for bathing. Conclusion: Through our survey, we identified possible risk factors that might be responsible for the increasing epidemic of familial dermatophytosis in India, including sharing of soaps and towels, washing clothes in the same vessel, sharing of lavatories, abuse of topical steroids and over the counter topicals, and use of antiseptic soaps that kill normal flora.