A new study published in Clinical Dermatology Review evaluated the changing geographical trends in the clinico-mycological profile of dermatophytosis and its antifungal susceptibility patterns. 

This was a descriptive cross-sectional study conducted in a tertiary care hospital of South India that included 211 patients with clinically diagnosed dermatophytosis. For all patients, history taking, examination, and a Potassium Hydroxide wet mount were carried out. Additionally, skin scrapings were taken for fungal culture and antifungal susceptibility tests against ten commonly used antifungal agents, using the Broth Microdilution method as per CLSI M38-A2 guidelines.

The findings revealed that tinea incognito was the most common presentation and Trichophyton rubrum was the predominantly isolated dermatophyte. Recurrent dermatophytosis was seen in 11.84% subjects. Terbinafine was the most effective systemic agent and luliconazole was the most effective topical agent. While itraconazole and luliconazole were the most effective systemic and topical agents, respectively, at their lowest minimum inhibitory concentrations – inhibiting T. rubrum isolates in vivo. On the other hand, fluconazole, followed by griseofulvin, showed the least efficacy. In vitro, microbiological resistance to griseofulvin was found in 15.3% of cases.

In inference, it was stated that the rapidly evolving geographical trends in clinico-epidemiological profiles of dermatophytosis and its varying antifungal susceptibility patterns emphasize the need for updating the knowledge of this disease in the global scenario. The susceptibility pattern of dermatophytes varies from species to species; thus, it is important to determine the fungal isolate, particularly, in cases of recalcitrant dermatophytosis. An increase in MIC is not the only factor responsible for recurrence or recalcitrance. They may occur due to re-infection from affected family members or the environment, compromised host immunity or an inadequate duration of antifungal therapy. In most instances, patients tend to stop topical treatment as soon as they get partial relief. Therefore, appropriate treatment of any infected close contacts along with counseling of rural populations with behavioral and lifestyle modifications is necessary.

Source: Clinical Dermatology Review. 2021;5:85-91. doi: 10.4103/CDR.CDR_64_20