Dermatophytes, i.e., the keratinophilic fungi, causing infections in keratin rich areas such as skin, hair, and nail produce inflammatory response. Patients with dermatophytosis usually present to clinicians with symptoms of intense itching and cosmetic concerns.
Dermatophytosis is a very common skin disorder and public health problem in India. Dermatologists as well as general practitioners both encounter several cases of dermatophytosis in their regular clinical practice. The prevalence and pattern of dermatophytosis differ based on the season and geographic and socioeconomic factors.
Dermatophytosis can be acute or chronic in nature. Chronic dermatophytosis is characterized by the presence of persistent or recurrent episodes of dermatophytosis for more than 1 year despite adequate treatment with antifungal drugs. Chronic dermatophytosis was no so very common few decades back and mostly the chronic infection used to be limited to the nail. However, there has been significant change in this pattern. In last few years, there has been significant increase in number of chronic dermatophytosis cases. Dermatophytosis, both the 2disease and its treatment, can have significant impact on the quality of life of the patient. In addition, it can add to economic burden on the family of the patient.
Several studies have been conducted by investigators from different geographical areas of the country and reported their observations (Table 1). In addition to the increased prevalence, there have been concerns related to antifungal drug resistance in India. In this chapter, we have discussed the current status of dermatophytosis in India.
A study from five cities in India (Mumbai, Delhi, Lucknow, Kolkata, and Hyderabad) reported tinea corporis (71.4%) to be the most common clinical type followed by tinea cruris (62.0%). Trichophyton rubrum (T. rubrum) was the most common organism responsible for fungal infection (Table 1) in this study. Trichophyton mentagrophytes was reported to be common in humid conditions, whereas noncoastal areas showed more prevalence of T. rubrum.
Tinea corporis and T. mentagrophytes are reported to be the most common clinical type and species respectively among the patients with chronic dermatophytosis. Waist and back are the commonly affected areas in females and male patients with chronic dermatophytosis, respectively. Another small study (n = 30) reported waist and crural areas to be commonly affected areas. Large area of body involvement, diabetes mellitus, and long-term use of systemic corticosteroids are the risk factors for the development of chronic dermatophytosis.
Family history, sharing of fomites, washing clothing together, use of synthetic tight clothes, and misuse of topical corticosteroids are also common in patients with chronic dermatophytosis.
Today, another important concern is alarming rise in the rates of chronic, recurrent cases of steroid-modified dermatophytosis and resistance to the commonly used antifungal agents.3
A study from five cities in India reported mean minimum inhibitory concentration of terbinafine above the reference range. Another study reported high rates of resistance to oral antifungals (terbinafine, fluconazole, and griseofulvin).
Dermatophytosis is a common skin disorder in patients presenting to dermatologists as well as general practitioners. Several studies from India suggest that chronic dermatophytosis is a common problem in Indian population. T. mentagrophytes has emerged as the most common causative agent for chronic dermatophytosis. Resistance to commonly used antifungals is another important and rising concern.
- Tahiliani S, Saraswat A, Lahiri AK, Shah A, Hawelia D, Shah GK, et al. Etiological prevalence and antifungal sensitivity patterns of dermatophytosis in India - A multicentric study. Indian J Dermatol Venereol Leprol. 2021;87:800-6.
- Rajamohan R, Raj R, Chellam J, Rengasamy M. Epidemiological trends and clinicomycological profile of chronic dermatophytosis: A descriptive study from South India. Indian J Dermatol. 2021;66:445.
- Verma SB, Panda S, Nenoff P, Singal A, Rudramurthy SM, Uhrlass S, et al. The unprecedented epidemic-like scenario of dermatophytosis in India: I. Epidemiology, risk factors and clinical features. Indian J Dermatol Venereol Leprol. 2021;87:154-75.
- Shenoy MM, Rengasamy M, Dogra S, Kaur T, Asokan N, Sarveswari KN, et al. A multicentric clinical and epidemiological study of chronic and recurrent dermatophytosis in India. Mycoses. 2022;65:13-23.
- Saha I, Podder I, Chowdhury SN, Bhattacharya S. Clinico-mycological profile of treatment-naïve, chronic, recurrent and steroid-modified dermatophytosis at a tertiary care centre in Eastern India: An institution-based cross-sectional study. Indian Dermatol Online J. 2021;12:714-21.
- Tuknayat A, Bhalla M, Kaur A, Garg S. Familial dermatophytosis in India: A study of the possible contributing risk factors. J Clin Aesthet Dermatol. 2020;13:58-60.
- Ankad BS, Mukherjee SS, Nikam BP, Reshme AS, Sakhare PS, Mural PH. Dermoscopic characterization of dermatophytosis: A preliminary observation. Indian Dermatol Online J. 2020;11:202-7.
- Patel NH, Padhiyar JK, Patel AP, Chhebber AS, Patel BR, Patel TD. Psychosocial and financial impact of disease among patients of dermatophytosis, a questionnaire-based observational study. Indian Dermatol Online J. 2020;11:373-7.
- Jain S, Kabi S, Swain B. Current trends of dermatophytosis in Eastern Odisha. J Lab Physicians. 2020;12:10-4.
- Kalekhan FM, Asfiva A, Shenoy MM, Vishal B, Pinto M, Hegde SP. Role of tinea unguium and other factors in chronic and recurrent dermatophytosis: A case control study. Indian Dermatol Online J. 2020;11:747-52.
- Singh A, Masih A, Monroy-Nieto J, Singh PK, Bowers J, Travis J, et al. A unique multidrug-resistant clonal Trichophyton population distinct from Trichophyton mentagrophytes/Trichophyton interdigitale complex causing an ongoing alarming dermatophytosis outbreak in India: Genomic insights and resistance profile. Fungal Genet Biol. 2019;133:103266.