Chronic Dermatophytosis: Clinico-Mycological Determinants and Antifungal Susceptibility Pattern

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.

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.

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.

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.