Handbook of Fungal Infections Kiran V Godse, Anant Patil
INDEX
ABCDEFGHIKLMNOPQRSTUVWXZ
Page numbers followed by, f refer to figure, and t refer to table.
A
Allylamines 52, 53, 59, 69, 72
Alopecia 62
Amorolfine 69
Amphotericin B 54, 70
colloidal dispersion 55
deoxycholate 52
lipid complex 52, 55
Anemia 55
Anidulafungin 52
Antibiotics, utilization of 34
Antifungal
agents 52, 63
classification of 52t, 53, 53t
pharmacology of 52
resistance 62
topical 81
Antimetabolites 53, 61
Archaea 33
Athlete's foot 14
Azoles 52, 53, 56, 59
mechanism of action of 56f
B
Bacteria 33
Balanitis 34, 37, 37f, 38, 39
types of 38
Balanoposthitis 37
Benzylamines 69
Bifonazole 69
Bone marrow suppression 62
Burning 34
Butenafine 69
Butoconazole 36
C
Candida 34
albicans 33, 55, 63
infections 16
krusei 63
neoformans 63
Candidal balanitis 38
Candidal intertrigo, systemic agents for 84
Candidemia 58
Candidiasis, topical agents for 73
Cardiac dysfunction 82
Caspofungin 52, 64
Castellani's paint 70
Cell membrane 53
Cell wall 53
Central nervous system 58
Cerebrospinal fluid 57
Chemical structure 52
Ciclopirox 53, 70
olamine 71, 72
Circinate balanitis 38
Clioquinol 53
Clotrimazole 36, 52, 69, 72
Corticosteroids 62
modified double-edged tinea 10f
topical 42, 43, 47
Cryptococcus neoformans 63
D
Dermatophyte 1
infection 12, 19
Dermatophytosis 1, 5, 7, 8t, 11, 16, 43
chronic 1, 4, 11f
current trends of 1
epidemiological studies of 3t
management of 67
recalcitrant 44
recurrent 4
Dermoscopy 20
Diabetes mellitus 35, 38, 45
Distal lateral subungual onychomycosis 19
Drug
interactions 59
resistance 84
E
Eberconazole 69
Echinocandins 52, 53, 60, 63
Econazole 69, 72
Efinaconazole 69
Electrolyte abnormalities 55
Epidermophyton floccosum 19
Erythematous papules, margin of 48f
Estrogen 35
F
Favus 17
Fenticonazole 69
Finger nail involvement 77
Fixed drug eruption 75
Fluconazole 36, 40, 52, 57, 63, 64, 69, 75, 78, 81, 82, 84
single dose 84
Flucytosine 53, 61
Fungal
culture 18
nail infections 19
Fungi 33
G
Gastrointestinal adverse events 55, 62
Glabrous dermatophytosis 3
Glans penis, inflammation of 37
Griseofulvin 52, 53, 61, 75, 80, 81
H
Hailey–Hailey disease 12
Hair 8
Hamycin 54
Headache 55
Heart failure, congestive 75
Hepatic dysfunction 82
Hepatotoxicity 62
Human immunodeficiency virus 45
Hydroxypyridinones 70
Hyperkeratotic lesions 71
Hyperpigmentation 23f, 29f
Hypersensitivity 57
Hypopigmentation 25f
I
Imidazoles 52, 56, 69, 72
Immunity, cell-mediated 44
Incognito 45
Indian Association of Dermatologists, Venereologists and Leprologists Task Force against Recalcitrant Tinea 67
Indian Expert Forum Consensus Group 67
Interdigital tinea pedis 15f
Iodoquinol 53
Isoconazole 72
Itching 34
Itraconazole 40, 52, 58, 64, 74, 77, 81, 82, 84
K
Keratinophilic fungi 1
Keratolytics, topical 72
Kerion 17
Ketoconazole 52, 57, 69, 72, 84
absorption of 57
L
Lacquer preparations 71
Lactation 68
Lichenification 28f
Liposomal amphotericin B 52, 55
Liver function test 75
Luliconazole 69
M
Majocchi's granuloma 11
Meatitis 40
Micaceous balanitis 38
Micafungin 52
Miconazole 36, 52, 69, 72
Microsporum
audouinii 46
canis 16
gypseum 9, 46
Mitotic inhibitor 53, 61
Monotherapy 68
topical 73
Morpholines 69
Mucocutaneous candidiasis 33, 58
Multiple site involvement 3
N
Naftifine 69
Nail 8
Naïve infections 68
Nephrotoxicity 55
Newer amphotericin B formulations 55
Nystatin 36, 52, 54, 55
O
Obesity 39
Onychomycosis 8, 71, 73
Oral contraceptives 35
Oral immunosuppressants 45
Oral itraconazole 81
Oxaboroles 70
Oxiconazole 69
P
Pediatric age group 68
Pharmacokinetics 62
Phimosis 38, 40
Pityriasis versicolor
systemic agents for 83
topical agents for 72
Polyene 52–54, 70
antibiotics, fungicidal mechanism of 54f
Posaconazole 52, 64
Potassium
hydroxide mount 18, 18f
iodide 53
saturated solution of 53
Pregnancy 35, 68, 81
Pseudoepitheliomatous keratotic 38
Q
Quinoline derivative 53
R
Renal dysfunction 82
Renal function tests 82t
Ringworm infection 7
S
Scaly lesions 71
Sertaconazole 69
Skin 8
diseases 12
rashes 62
Sodium-glucose cotransporter-2 inhibitors, utilization of 35
Soreness 34
Steroids
modified tinea 11, 45, 48f
topical 42
Subacute cutaneous lupus erythematosus 75
SUBA-itraconazole 58
Superficial fungal infections 66, 68, 77
systemic agents for 73
treatment of 66, 67
Systemic antifungal
agents 74t
therapy 76
indications of 73
Systemic lupus erythematosus 13, 75
T
Tavaborole 70
Terbinafine 52, 60, 69, 72, 74, 79, 81–83
mechanism of action of 60f
Terconazole 36
Tinea 7, 23f, 25f, 28f, 32f
barbae 8, 18
capitis 8, 16, 18f, 31f, 78, 79, 80
drug of choice for 80
inflammatory 17f
clinical presentations of 7
corporis 2, 3, 8, 9, 11, 12, 77–80
et cruris 3
rounded erythematous scaly lesion of 9f
cruris 3, 8, 9, 12, 77–80
et corporis 10
intensely itchy patch of 13f
faciei 8, 9, 12, 14f, 46, 77–80
healing 29f
incognito 11, 45
treatment of 76
infection 7, 30f, 42
chronic 3
diagnosis of 20
recurrent 3
manuum 8, 9, 16
pedis 8, 14, 15, 73, 77–80
progenetica 50f
pseudoimbricata 10, 46, 49f
pubogenetica 47
types of 8t
unguium 8, 19, 20, 77, 78, 79
drug of choice for 79
Tioconazole 36
Tolnaftate 70
Topical antifungal 81
agents 69t
therapy, indications of 68
Topical corticosteroids 42, 43, 47
role of 71
Trachyonychia 19
Triazoles 52, 57, 69
first-generation 57
second-generation 59
Trichophyton
concentricum 10, 46
interdigitale 14, 19, 85
mentagrophytes 2, 3, 9, 45
rubrum 2, 3, 9, 45, 85
tonsurans 46, 85
verrucosum 9
violaceum 9
U
Urinary catheterization 39
Urinary tract infections 57
V
Vaginal discharge 34
Viruses 33
Voriconazole 52, 64
Vulvovaginal candidiasis 34, 35f
treatment of 36
W
Whitfield ointment 70
Wood's lamp examination 17
X
Xerosis dryness 24f
Z
Zinc pyrithione 53
×
Chapter Notes

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Current Trends of Dermatophytosis in IndiaCHAPTER 1

Kiran V Godse,
Anant Patil
 
INTRODUCTION
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.
 
EPIDEMIOLOGY
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
TABLE 1   Epidemiological studies of dermatophytosis in India.
Authors
Number of patients
Study setting
Results
Tahiliani et al., 2021
395 patients with dermatophytosis
Five cities of India (Mumbai, Delhi, Lucknow, Kolkata, and Hyderabad)
  • Trichophyton rubrum (T. rubrum): 68.4%
  • Trichophyton mentagrophytes (T. mentagrophytes): 29.3%
Rajamohan et al., 2021
64 patients with chronic dermatophytosis
South India
  • Tinea corporis: Most common clinical type (71.9%)
  • T. mentagrophytes: Most common species (46.4%); T. rubrum (39.3%)
Shenoy et al., 2022
41,421 patients
13 centers from India
  • Glabrous dermatophytosis: 7174 (17.31%) patients
  • Multiple site involvement: 69.58%
  • Tinea cruris: 79.99%
  • Tinea corporis: 75.69%
Saha et al., 2021
111 patients
Tertiary care center, Eastern India
  • Female: Male: 1.7:1
  • Chronic tinea infection: 34.2%
  • Recurrent tinea infection: 14.4%
  • Tinea corporis et cruris: 41.4%
  • Tinea corporis: 34.2%
  • The most common cause for treatment naïve and recurrent cases: T. rubrum
  • The most common cause of chronic and steroid modified cases: T. mentagrophytes4
Pathania et al., 2018
150 with recurrent dermatophytosis
Tertiary care center from North India
  • Recurrent dermatophytosis: 9.3%
  • Most common species: T. mentagrophytes (40%)
  • T. rubrum: 32.2%
Jain et al., 2020
1,200 patients
Tertiary care center from Eastern Odisha, India
  • Most common clinical presentation: Tinea corporis
  • Most common dermatophytes: T. mentagrophytes (77.5%), T. rubrum (13.3%)
Kalekhan et al., 2020
80 patients with chronic recurrent dermatosis and 80 controls
Tertiary care hospital
  • Chronic dermatophytosis: 44 (55%)
  • Recurrent dermatophytosis: 36 (45%)5
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).
 
CONCLUSION
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.
SUGGESTED READINGS
  1. 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.
  1. 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.
  1. 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.
  1. 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.
  1. 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.
  1. 6 Pathania S, Rudramurthy SM, Narang T, Saikia UN, Dogra S. A prospective study of the epidemiological and clinical patterns of recurrent dermatophytosis at a tertiary care hospital in India. Indian J Dermatol Venereol Leprol. 2018;84:678-84.
  1. 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.
  1. 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.
  1. 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.
  1. Jain S, Kabi S, Swain B. Current trends of dermatophytosis in Eastern Odisha. J Lab Physicians. 2020;12:10-4.
  1. 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.
  1. 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.