Heeding the surge in dermatophytosis in the subcontinent, a study was undertaken to isolate and identify common species causing dermatophyte infections and to know the in vitro efficacy of the common antifungals against them.

The present study selected 103 new cases that were not on any treatment for the past 3 months. Direct microscopic examination and fungal culture of skin scrapings were done. Fungi were identified on the basis of their macroscopic and microscopic features. Also, drug sensitivity of the dermatophytes to common antifungals was tested.

Overall, 55 cases were positive for dermatophytes, in culture; among these, 29 showed possible contamination. Trichophyton was the predominant organism (in 49 cases) with T. verrucosum being the commonest species (26 cases), followed by T. rubrum (15 patients), and T. mentagrophytes (8 cases). While all species of Trichophyton were found to be most sensitive to itraconazole amongst systemic antifungals.

In inference, it was stated that the causative agent for the dermatophytosis was changing in India. In the study cohort, T. verrucosum caused the maximum number of infections. The Trichophyton specie showed highest sensitivities to Itraconazole amongst systemic antifungals. The Trichophyton specie showed highest sensitivities to Itraconazole and luliconazole amongst systemic and topical antifungals

A study published in the Indian Journal of Clinical and Experimental Dermatology demonstrated that topical ciclopirox olamine, when applied twice daily for six weeks was effective in managing dermatophytosis infections in patients who were on oral itraconazole 100mg twice daily for 4 weeks. This modality rendered complete, clinical and mycological cure rates of 84.09%, 88.63% and 86.36%, respectively, in the study participants.

Ciclopirox olamine – a hydroxypyridone derivative, is a novel antifungal agent which is efficacious and safe in the management of dermatophytosis. This agent differs in structure and mechanism of action from the other known antifungal agents. The drug acts through chelation of polyvalent metal cations, such as ferric (Fe³⁺) and aluminium (Al³⁺), thereby causing inhibition of metal-dependent enzymes. This leads to the disruption of cellular activities – such as, mitochondrial electron transport processes, energy production, and nutrient intake across cell membranes, and the alteration of cell membrane permeability of fungi.

Source: Indian Journal of Dermatology. Mar-Apr 2020;65(2):118-122. doi: 10.4103/ijd.IJD_203_19.

Indian Journal of Clinical and Experimental Dermatology. 2020;6(4):349-355